Rate and rhythm are important in critically ill patients

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7420.931-c (Published 16 October 2003) Cite this as: BMJ 2003;327:931
  1. Egbert Pravinkumar, lecturer (e.pravinkumar{at}abdn.ac.uk)
  1. Academic Department of Intensive Care, Institute of Medical Sciences, Aberdeen AB25 2ZD

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

    Atrial arrythmias are common in critically ill patients and are often associated with cardiorespiratory instability and increased mortality. Both rate and rhythm control in the acute and short term is crucial in managing these patients. Atrial arrythmia in critically ill patients is usually multifactorial, and often the antiarrhythmic drugs do not need to be continued beyond the critical care unit unless there is a strong case to do so. Amiodarone, diltiazem, and magnesium infusions, βblockers, and procianamide are safe and efficacious in achieving this goal.24

    Direct current cardioversion is not useful in achieving sustained rate or rhythm control in critically ill patients.5 Amiodarone magnesium still remains the preferred drug for managing new onset atrial fibrillation in patients in critical care, and the awareness of amiodarone induced pulmonary toxicity remains high.


    • Competing interests None declared.


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