Atrial fibrillation (AFib) is an irregular and often rapid heart rhythm that can increase the risk of stroke, heart failure, and other complications. In critical care, healthcare providers work to control the heart rate, restore normal rhythm when feasible, and administer treatments to prevent complications like blood clots. The treatment of AFib in this setting typically involves heart rate reducing agents that allow the patient to convert to sinus rhythm. Close monitoring and specialized interventions are integral to managing atrial fibrillation effectively.
Critical Care
Critical care is a specialized branch of medicine dedicated to managing and treating patients with severe, life threatening conditions.
Critical care teams work collaboratively to assess, diagnose, and treat patients in critical conditions, including hemodynamic stabilization, organ support when needed, and treating the underlying cause of the illness. Critical care patients require constant medical attention and monitoring due to life threatening conditions or severe injuries.
Atrial Fibrillation
Atrial Fibrillation and Heart Failure
Atrial Fibrillation and Heart Failure
Atrial fibrillation (AF) and atrial flutter (AFL) are common arrhythmias in patients with left ventricular (LV) dysfunction.
In these patients, AF/AFL are often associated with a rapid ventricular response during the worsening of heart failure.1
Over 20% of patients with heart failure exhibit atrial fibrillation.
Interaction Between Atrial Fibrillation (AF) and Heart Failure (HF)
The interaction between HF and AF is increased through the action of mechanisms such as the rate-dependent deterioration of cardiac function, fibrosis, and the activation of neurohumoral vasoconstrictors.
Atrial fibrillation can worsen cardiac symptoms in patients with HF. Conversely, worsening HF can promote a rapid ventricular response in AF, further increasing the risk of HF.
Management Approaches for Heart Failure
In recent decades, advancements achieved in pharmacological treatment have significantly improved the prognosis of patients with chronic HF.
Among the medications recommended by guidelines for the improvement outcomes in chronic heart failure along with ACEi (angiotensin-converting enzyme inhibitor ) or ARB (angiotensin receptor blocker) or ARNi (angiotensin receptor‐neprilysin inhibitor), MRA (steroidal mineralocorticoid receptor antagonist) and SGLT2i (sodium‐glucose cotransporter‐2 inhibitor), especially in patients with HF and reduced ejection fraction (HFrEF), betablockers improved the prognosis by blocking sympathetic activity, reducing catecholamine release and heart rate improving cardiac remodeling.3,4
References:
- Nagai R, Kinugawa K, Inoue H, Atarashi H, Seino Y, Yamashita T, Shimizu W, Aiba T, Kitakaze M, Sakamoto A, Ikeda T, Imai Y, Daimon T, Fujino K, Nagano T, Okamura T, Hori M; J-Land Investigators. Urgent management of rapid heart rate in patients with atrial fibrillation/flutter and left ventricular dysfunction: comparison of the ultra-short-acting β1-selective blocker landiolol with digoxin (J-Land Study). Circ J. 2013;77(4):908-16. doi: 10.1253/circj.cj-12-1618. Epub 2013 Mar 15. PMID: 23502991.
- Iwahashi N, Takahashi H, Abe T, Okada K, Akiyama E, Matsuzawa Y, Konishi M, Maejima N, Hibi K, Kosuge M, Ebina T, Tamura K, Kimura K. Urgent Control of Rapid Atrial Fibrillation by Landiolol in Patients With Acute Decompensated Heart Failure With Severely Reduced Ejection Fraction. Circ Rep. 2019 Sep 26;1(10):422-430. doi: 10.1253/circrep.CR-19-0076. PMID: 33693079; PMCID: PMC7897576.
- McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Skibelund AK; ESC Scientific Document Group. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2023 Oct 1;44(37):3627-3639. doi: 10.1093/eurheartj/ehad195. Erratum in: Eur Heart J. 2024 Jan 1;45(1):53. doi: 10.1093/eurheartj/ehad613. PMID: 37622666.
- Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022 May 3;79(17):e263-e421. doi: 10.1016/j.jacc.2021.12.012. Epub 2022 Apr 1. Erratum in: J Am Coll Cardiol. 2023 Apr 18;81(15):1551. doi: 10.1016/j.jacc.2023.03.002. PMID: 35379503.
- Xie L, Chen J, Li Y, Liu G, Shen J, Li X, Yang Y, Chen Y, Luo S and Huang B (2025) Beta-blocker administration within 24 hours after admission to the intensive care unit and mortality in critical heart failure patients: a retrospective analysis from the MIMIC-IV database. Front. Pharmacol. 16:1514138. doi: 10.3389/fphar.2025.1514138
- Prins KW, Neill JM, Tyler JO, Eckman PM, Duval S. Effects of Beta-Blocker Withdrawal in Acute Decompensated Heart Failure: A Systematic Review and Meta- Analysis. JACC Heart Fail. 2015 Aug;3(8):647-53. doi:10.1016/j.jchf.2015.03.008