Sustained arrhythmias occur in approximately 10–15% of general ICU patients.1,2 As a general rule, the development of arrhythmias is a reflection of the severity of the underlying disease and they do not appear to be independent predictors of death, although they increase the risk of neurological sequela. Atrial arrhythmias (atrial fibrillation/atrial flutter) are the most common arrhythmia. AF/atrial flutter are usually secondary to the underlying disease process (respiratory failure), while ventricular arrhythmias are usually due to pre-existent cardiac disease or acute ischemia. Atrial arrhythmias are usually the consequence of acute respiratory failure (acute cor pulmonale–pulmonary hypertension, right ventricular failure, and atrial distension).3 Left ventricular systolic dysfunction (sepsis, ARDS, etc.) as well as abnormalities in fluid balance and electrolytes may contribute to the development of sustained arrhythmias in critically ill ICU patients. The management of arrhythmias in acutely ill ICU patients differs from that of patients with primary cardiac disease. Unfortunately, there is little (if any) evidence-based literature to guide the management of these arrhythmias in the ICU.


Atrial Fibrillation Accessory Pathway Ventricular Response Sick Sinus Syndrome Underlying Heart Disease 
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  1. 1.
    Annane D, Sebille V, Duboc D, et al. Incidence and prognosis of sustained arrhythmias in critically ill patients. Am J Respir Crit Care Med. 2008;178:20–25.PubMedCrossRefGoogle Scholar
  2. 2.
    Artucio H, Pereira M. Cardiac arrhythmias in critically ill patients: epidemiologic study. Crit Care Med. 1990;18:1383–1388.PubMedCrossRefGoogle Scholar
  3. 3.
    Vieillard-Baron A, Schmitt JM, Augarde R, et al. Acute cor pulmonale in acute respiratory distress syndrome submitted to protective ventilation: incidence, clinical implications, and prognosis. Crit Care Med. 2001;29:1551–1555.PubMedCrossRefGoogle Scholar
  4. 4.
    Onalan O, Crystal E, Daoulah A, et al. Meta-analysis of magnesium therapy for the acute management of rapid atrial fibrillation. Am J Cardiol. 2007;99:1726–1732.PubMedCrossRefGoogle Scholar
  5. 5.
    Cagli K, Ozeke O, Ergun K, et al. Effect of low-dose amiodarone and magnesium combination on atrial fibrillation after coronary artery surgery. J Card Surg. 2006;21:458–464.PubMedCrossRefGoogle Scholar
  6. 6.
    Davey MJ, Teubner D. A randomized controlled trial of magnesium sulfate, in addition to usual care, for rate control in atrial fibrillation. Ann Emerg Med. 2005;45:347–353.PubMedCrossRefGoogle Scholar
  7. 7.
    Auer J, Weber T, Berent R, et al. Serum potassium level and risk of postoperative atrial fibrillation in patients undergoing cardiac surgery. J Am Coll Cardiol. 2004;44:938–939.PubMedCrossRefGoogle Scholar
  8. 8.
    Galve E, Rius T, Ballester R, et al. Intravenous amiodarone in treatment of recent-onset atrial fibrillation: results of a randomized, controlled study. J Am Coll Cardiol. 1996;27:1079–1082.PubMedCrossRefGoogle Scholar
  9. 9.
    Sleeswijk ME, Tulleken JE, Van NT, et al. Efficacy of magnesium–amiodarone step-up scheme in critically ill patients with new-onset atrial fibrillation: a prospective observational study. J Intensive Care Med. 2008;23:61–66.PubMedCrossRefGoogle Scholar
  10. 10.
    Singer DE, Albers GW, Dalen JE, et al. Antithrombotic therapy in atrial fibrillation: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133:546S–592S.PubMedCrossRefGoogle Scholar
  11. 11.
    Weigner MJ, Caulfield TA, Danias PG, et al. Risk for clinical thromboembolism associated with conversion to sinus rhythm in patients with atrial fibrillation lasting less than 48 hours. Ann Intern Med. 1997;126:615–620.PubMedGoogle Scholar

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© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Division of Pulmonary and Critical Care MedicineEastern Virginia Medical SchoolNorfolkUSA

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