IBCC Episode 114 - Atrial Fibrillation

In this episode of The Internet Book of Critical Care Podcast, Josh and Adam delve into the complexities of atrial fibrillation (AFib) and atrial flutter in critically ill patients, highlighting the differences between ICU patients and those in outpatient or emergency settings. They discuss diagnosis, emphasizing the importance of EKGs and differentiating AFib from other arrhythmias like multifocal atrial tachycardia (MAT). The conversation covers heart rate management, prevention strategies such as magnesium supplementation, and common causes of AFib in the ICU, including electrolyte imbalances and adrenergic states. They address the rare instances of instability directly caused by AFib, the importance of treating underlying conditions, and specific considerations for Wolff-Parkinson-White patients. The hosts explore rate versus rhythm control, favoring rhythm control for new-onset AFib (NOF) and discussing pharmacological interventions like magnesium, amiodarone, and ibutylide, as well as direct cardioversion. Finally, they discuss anticoagulation, acknowledging the limited evidence and potential risks in the ICU setting, and offer pearls and pitfalls for managing AFib in critical care.