Clinical review: Treatment of new-onset atrial fibrillation in medical intensive care patients: A clinical framework

Mengalvio E. Sleeswijk, Trudeke Van Noord, Jaap E. Tulleken, Jack J.M. Ligtenberg, Armand R.J. Girbes, Jan G. Zijlstra

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

Atrial fibrillation occurs frequently in medical intensive care unit patients. Most intensivists tend to treat this rhythm disorder because they believe it is detrimental. Whether atrial fibrillation contributes to morbidity and/or mortality and whether atrial fibrillation is an epiphenomenon of severe disease, however, are not clear. As a consequence, it is unknown whether treatment of the arrhythmia affects the outcome. Furthermore, if treatment is deemed necessary, it is not known what the best treatment is. We developed a treatment protocol by searching for the best evidence. Because studies in medical intensive care unit patients are scarce, the evidence comes mainly from extrapolation of data derived from other patient groups. We propose a treatment strategy with magnesium infusion followed by amiodarone in case of failure. Although this strategy seems to be effective in both rhythm control and rate control, the mortality remained high. A randomised controlled trial in medical intensive care unit patients with placebo treatment in the control arm is therefore still defendable.

Original languageEnglish
Article number233
JournalCritical Care
Volume11
Issue number6
DOIs
Publication statusPublished - 12 Nov 2007

Cite this

Sleeswijk, Mengalvio E. ; Van Noord, Trudeke ; Tulleken, Jaap E. ; Ligtenberg, Jack J.M. ; Girbes, Armand R.J. ; Zijlstra, Jan G. / Clinical review : Treatment of new-onset atrial fibrillation in medical intensive care patients: A clinical framework. In: Critical Care. 2007 ; Vol. 11, No. 6.
@article{a74cc6019a394aa388d49ea1cf5d28d0,
title = "Clinical review: Treatment of new-onset atrial fibrillation in medical intensive care patients: A clinical framework",
abstract = "Atrial fibrillation occurs frequently in medical intensive care unit patients. Most intensivists tend to treat this rhythm disorder because they believe it is detrimental. Whether atrial fibrillation contributes to morbidity and/or mortality and whether atrial fibrillation is an epiphenomenon of severe disease, however, are not clear. As a consequence, it is unknown whether treatment of the arrhythmia affects the outcome. Furthermore, if treatment is deemed necessary, it is not known what the best treatment is. We developed a treatment protocol by searching for the best evidence. Because studies in medical intensive care unit patients are scarce, the evidence comes mainly from extrapolation of data derived from other patient groups. We propose a treatment strategy with magnesium infusion followed by amiodarone in case of failure. Although this strategy seems to be effective in both rhythm control and rate control, the mortality remained high. A randomised controlled trial in medical intensive care unit patients with placebo treatment in the control arm is therefore still defendable.",
author = "Sleeswijk, {Mengalvio E.} and {Van Noord}, Trudeke and Tulleken, {Jaap E.} and Ligtenberg, {Jack J.M.} and Girbes, {Armand R.J.} and Zijlstra, {Jan G.}",
year = "2007",
month = "11",
day = "12",
doi = "10.1186/cc6136",
language = "English",
volume = "11",
journal = "Critical Care",
issn = "1466-609X",
publisher = "Springer Science + Business Media",
number = "6",

}

Clinical review : Treatment of new-onset atrial fibrillation in medical intensive care patients: A clinical framework. / Sleeswijk, Mengalvio E.; Van Noord, Trudeke; Tulleken, Jaap E.; Ligtenberg, Jack J.M.; Girbes, Armand R.J.; Zijlstra, Jan G.

In: Critical Care, Vol. 11, No. 6, 233, 12.11.2007.

Research output: Contribution to journalReview articleAcademicpeer-review

TY - JOUR

T1 - Clinical review

T2 - Treatment of new-onset atrial fibrillation in medical intensive care patients: A clinical framework

AU - Sleeswijk, Mengalvio E.

AU - Van Noord, Trudeke

AU - Tulleken, Jaap E.

AU - Ligtenberg, Jack J.M.

AU - Girbes, Armand R.J.

AU - Zijlstra, Jan G.

PY - 2007/11/12

Y1 - 2007/11/12

N2 - Atrial fibrillation occurs frequently in medical intensive care unit patients. Most intensivists tend to treat this rhythm disorder because they believe it is detrimental. Whether atrial fibrillation contributes to morbidity and/or mortality and whether atrial fibrillation is an epiphenomenon of severe disease, however, are not clear. As a consequence, it is unknown whether treatment of the arrhythmia affects the outcome. Furthermore, if treatment is deemed necessary, it is not known what the best treatment is. We developed a treatment protocol by searching for the best evidence. Because studies in medical intensive care unit patients are scarce, the evidence comes mainly from extrapolation of data derived from other patient groups. We propose a treatment strategy with magnesium infusion followed by amiodarone in case of failure. Although this strategy seems to be effective in both rhythm control and rate control, the mortality remained high. A randomised controlled trial in medical intensive care unit patients with placebo treatment in the control arm is therefore still defendable.

AB - Atrial fibrillation occurs frequently in medical intensive care unit patients. Most intensivists tend to treat this rhythm disorder because they believe it is detrimental. Whether atrial fibrillation contributes to morbidity and/or mortality and whether atrial fibrillation is an epiphenomenon of severe disease, however, are not clear. As a consequence, it is unknown whether treatment of the arrhythmia affects the outcome. Furthermore, if treatment is deemed necessary, it is not known what the best treatment is. We developed a treatment protocol by searching for the best evidence. Because studies in medical intensive care unit patients are scarce, the evidence comes mainly from extrapolation of data derived from other patient groups. We propose a treatment strategy with magnesium infusion followed by amiodarone in case of failure. Although this strategy seems to be effective in both rhythm control and rate control, the mortality remained high. A randomised controlled trial in medical intensive care unit patients with placebo treatment in the control arm is therefore still defendable.

UR - http://www.scopus.com/inward/record.url?scp=41949091671&partnerID=8YFLogxK

U2 - 10.1186/cc6136

DO - 10.1186/cc6136

M3 - Review article

VL - 11

JO - Critical Care

JF - Critical Care

SN - 1466-609X

IS - 6

M1 - 233

ER -