Management of acute atrial fibrillation in the intensive care unit: An international survey. Wetterslev, M., Møller, M. H., Granholm, A., Hassager, C., Haase, N., Aslam, T. N., Shen, J., Young, P. J., Aneman, A., Hästbacka, J., Siegemund, M., Cronhjort, M., Lindqvist, E., Myatra, S. N., Kalvit, K., Arabi, Y. M., Szczeklik, W., Sigurdsson, M. I., Balik, M., Keus, F., Perner, A., & AFIB-ICU collaborators Acta Anaesthesiologica Scandinavica, 66(3):375–385, March, 2022.
doi  abstract   bibtex   
BACKGROUND: Atrial fibrillation (AF) is common in intensive care unit (ICU) patients and is associated with poor outcomes. Different management strategies exist, but the evidence is limited and derived from non-ICU patients. This international survey of ICU doctors evaluated the preferred management of acute AF in ICU patients. METHOD: We conducted an international online survey of ICU doctors with 27 questions about the preferred management of acute AF in the ICU, including antiarrhythmic therapy in hemodynamically stable and unstable patients and use of anticoagulant therapy. RESULTS: A total of 910 respondents from 70 ICUs in 14 countries participated in the survey with 24%-100% of doctors from sites responding. Most ICUs (80%) did not have a local guideline for the management of acute AF. The preferred first-line strategy for the management of hemodynamically stable patients with acute AF was observation (95% of respondents), rhythm control (3%), or rate control (2%). For hemodynamically unstable patients, the preferred strategy was observation (48%), rhythm control (48%), or rate control (4%). Overall, preferred antiarrhythmic interventions included amiodarone, direct current cardioversion, beta-blockers other than sotalol, and magnesium in that order. A total of 67% preferred using anticoagulant therapy in ICU patients with AF, among whom 61% preferred therapeutic dose anticoagulants and 39% prophylactic dose anticoagulants. CONCLUSION: This international survey indicated considerable practice variation among ICU doctors in the clinical management of acute AF, including the overall management strategies and the use of antiarrhythmic interventions and anticoagulants.
@article{wetterslev_management_2022,
	title = {Management of acute atrial fibrillation in the intensive care unit: {An} international survey},
	volume = {66},
	issn = {1399-6576},
	shorttitle = {Management of acute atrial fibrillation in the intensive care unit},
	doi = {10.1111/aas.14007},
	abstract = {BACKGROUND: Atrial fibrillation (AF) is common in intensive care unit (ICU) patients and is associated with poor outcomes. Different management strategies exist, but the evidence is limited and derived from non-ICU patients. This international survey of ICU doctors evaluated the preferred management of acute AF in ICU patients.
METHOD: We conducted an international online survey of ICU doctors with 27 questions about the preferred management of acute AF in the ICU, including antiarrhythmic therapy in hemodynamically stable and unstable patients and use of anticoagulant therapy.
RESULTS: A total of 910 respondents from 70 ICUs in 14 countries participated in the survey with 24\%-100\% of doctors from sites responding. Most ICUs (80\%) did not have a local guideline for the management of acute AF. The preferred first-line strategy for the management of hemodynamically stable patients with acute AF was observation (95\% of respondents), rhythm control (3\%), or rate control (2\%). For hemodynamically unstable patients, the preferred strategy was observation (48\%), rhythm control (48\%), or rate control (4\%). Overall, preferred antiarrhythmic interventions included amiodarone, direct current cardioversion, beta-blockers other than sotalol, and magnesium in that order. A total of 67\% preferred using anticoagulant therapy in ICU patients with AF, among whom 61\% preferred therapeutic dose anticoagulants and 39\% prophylactic dose anticoagulants.
CONCLUSION: This international survey indicated considerable practice variation among ICU doctors in the clinical management of acute AF, including the overall management strategies and the use of antiarrhythmic interventions and anticoagulants.},
	language = {eng},
	number = {3},
	journal = {Acta Anaesthesiologica Scandinavica},
	author = {Wetterslev, Mik and Møller, Morten Hylander and Granholm, Anders and Hassager, Christian and Haase, Nicolai and Aslam, Tayyba Naz and Shen, Jiawei and Young, Paul J. and Aneman, Anders and Hästbacka, Johanna and Siegemund, Martin and Cronhjort, Maria and Lindqvist, Elin and Myatra, Sheila N. and Kalvit, Kushal and Arabi, Yaseen M. and Szczeklik, Wojciech and Sigurdsson, Martin I. and Balik, Martin and Keus, Frederik and Perner, Anders and {AFIB-ICU collaborators}},
	month = mar,
	year = {2022},
	pmid = {34870855},
	keywords = {Anti-Arrhythmia Agents, Atrial Fibrillation, Humans, Intensive Care Units, Sotalol, Surveys and Questionnaires, anticoagulant therapy, atrial fibrillation, intensive care unit, management strategies},
	pages = {375--385},
}
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