Rate and rhythm are important in critically ill patients

doi:10.1136/bmj.327.7420.931-c

BMJ 2003;327:931-932 (18 October), doi:10.1136/bmj.327.7420.931-c

Letter

Rate and rhythm are important in critically ill patients

The first 150 words of the full text of this article appear below.

EDITOR—The editorial by Boos et al reaffirms that ratecontrol is not inferior to rhythm control in preventing deathand morbidity due to cardiovascular causes in atrial fibrillation.¹However, this information should not be extrapolated to criticallyill medical and surgical patients.

Atrial arrythmias are common in critically ill patients andare often associated with cardiorespiratory instability andincreased mortality. Both rate and rhythm control in the acuteand short term is crucial in managing these patients. Atrialarrythmia in critically ill patients is usually multifactorial,and often the antiarrhythmic drugs do not need to be continuedbeyond the critical care unit unless there is a strong caseto do so. Amiodarone, diltiazem, and magnesium infusions, ${beta}$ blockers,and procianamide are safe and efficacious in achieving thisgoal.^2-4

Direct current cardioversion is not useful in achieving sustainedrate or rhythm control in critically ill patients.⁵ Amiodaronemagnesium still remains . . . [Full text of this article]

Egbert Pravinkumar, lecturer

Academic Department of Intensive Care, Institute of Medical Sciences, Aberdeen AB25 2ZD e.pravinkumar@abdn.ac.uk

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Relevant Article

Persistent atrial fibrillation: rate control or rhythm control: Christopher J Boos, Ranjit S More, and Jörg Carlsson
BMJ 2003 326: 1411-1412. [Extract] [Full Text] [PDF]