[Rational management of atrial fibrillation in intensive care]

Atrial fibrillation (AF) occurs frequently in intensive care unit (ICU) patients and after coronary bypass graft (CABG) and valve surgery, with the peak incidence on postoperative days 2 and 3. Moreover, AF is one of the most common complications after thoracic surgery, e.g. video-assisted thoracic surgery (VATS), lobectomy or extrapleural pneumonectomy. Prophylaxis with beta-blockers can reduce postoperative incidence of AF. The acute treatment of new-onset AF involves rhythm and frequency control and depends on whether the patient is hemodynamically stable or not. Rate control can be performed with beta-blockers or calcium-channel-blockers. Amiodarone is an effective and safe drug for converting AF to sinus rhythm. Conversion of AF should not be attempted 48 h after onset without anticoagulation or transesophageal echocardiography to rule out intracardiac thrombus formation. In order to avoid thromboembolism after cardioversion, an effective anticoagulation is mandatory.