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.
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