Management of acute atrial fibrillation in the intensive care unit: An international survey. Issue 3 (14th December 2021)

• Record Type: Journal Article
• Authors: Wetterslev, Mik; Møller, Morten Hylander; Granholm, Anders; Hassager, Christian; Haase, Nicolai; Aslam, Tayyba Naz; Shen, Jiawei; Young, Paul J.; Aneman, Anders; Hästbacka, Johanna; Siegemund, Martin; Cronhjort, Maria; Lindqvist, Elin; Myatra, Sheila N.; Kalvit, Kushal; Arabi, Yaseen M.; Szczeklik, Wojciech; Sigurdsson, Martin I.; Balik, Martin; Keus, Frederik; Perner, Anders
• Other Names: Huang Bin investigator.; Yan Miao investigator.; Liu Wei investigator.; Deng Yanjiu investigator.; Zhang Lei investigator.; Suk Pavel investigator.; Mørk Sørensen Kasper investigator.; Andreasen Anne Sofie investigator.; Bestle Morten H. investigator.; Krag Mette investigator.; Poulsen Lone M. investigator.; Hildebrandt Thomas investigator.; Møller Kirsten investigator.; Møller‐Sørensen Hasse investigator.; Bove Jeppe investigator.; Kilsgaard Toke A. investigator.; Salam Idrees Ahmad investigator.; Brøchner Anne Craveiro investigator.; Strøm Thomas investigator.; Sølling Christoffer investigator.; Kolstrup Line investigator.; Boczan Mariusz investigator.; Rasmussen Bodil S. investigator.; Darfelt Iben S. investigator.; Jalkanen Ville investigator.; Lehto Pasi investigator.; Reinikainen Matti investigator.; Kárason Sigurbergur investigator.; Sigvaldason Kristinn investigator.; Olafsson Oddur investigator.; Vergis Sara investigator.; Mascarenhas Joanne investigator.; Shah Mehul investigator.; Haranath Sai Praveen investigator.; Van Der Poll Andrew investigator.; Gjerde Stig investigator.; Fossum Ole Kristian investigator.; Strand Kristian investigator.; Wangberg Helge L. investigator.; Berta Emil investigator.; Balsliemke Stephan investigator.; Robertson Andrew C. investigator.; Pedersen Robert investigator.; Dokka Vegard investigator.; Brügger‐Synnes Pascal investigator.; Czarnik Tomasz investigator.; Albshabshe Alia A. investigator.; Almekhlafi Ghaleb investigator.; Knight Agnes investigator.; Tegnell Emily investigator.; Sjövall Fredrik investigator.; Jakob Stephan investigator.; Filipovic Miodrag investigator.; Kleger Gian‐Reto investigator.; Eck Ruben J. investigator.;
• Is Part Of: Acta anaesthesiologica scandinavica. Volume 66:Issue 3(2022)
• Page Start: 375
• Page End: 385
• Publication Date: 2021-12-14
• Subjects: anticoagulant therapy -- atrial fibrillation -- intensive care unit -- management strategies; Anesthesiology -- Periodicals; Critical care medicine -- Periodicals; 617.9605
• DOI: 10.1111/aas.14007
• Languages: English
• ISSNs: 0001-5172

Abstract

Abstract: Background: Atrial fibrillation (AF) is common in intensive care unit (ICU) patients and is associated with poor outcomes. Different management strategies exist, but the evidence is limited and derived from non‐ICU patients. This international survey of ICU doctors evaluated the preferred management of acute AF in ICU patients. Method: We conducted an international online survey of ICU doctors with 27 questions about the preferred management of acute AF in the ICU, including antiarrhythmic therapy in hemodynamically stable and unstable patients and use of anticoagulant therapy. Results: A total of 910 respondents from 70 ICUs in 14 countries participated in the survey with 24%–100% of doctors from sites responding. Most ICUs (80%) did not have a local guideline for the management of acute AF. The preferred first‐line strategy for the management of hemodynamically stable patients with acute AF was observation (95% of respondents), rhythm control (3%), or rate control (2%). For hemodynamically unstable patients, the preferred strategy was observation (48%), rhythm control (48%), or rate control (4%). Overall, preferred antiarrhythmic interventions included amiodarone, direct current cardioversion, beta‐blockers other than sotalol, and magnesium in that order. A total of 67% preferred using anticoagulant therapy in ICU patients with AF, among whom 61% preferred therapeutic dose anticoagulants and 39% prophylactic dose anticoagulants. Conclusion: This international survey indicated considerable practice variation among ICU doctors in the clinical management of acute AF, including the overall management strategies and the use of antiarrhythmic interventions and anticoagulants.