Echocardiography guided management of atrial fibrillation

作者：Martin Balík, Philippe Vignon, Michelle S. Chew, Guido Tavazzi, Paul H. Mayo, Ghislaine Douflé, Jonathan Aron, J. Hastings, Bernard Cholley, Kateřina Jiroutková, M. Slama, Antoine Herpain, A.E.M. McLean · 发表于：Intensive Care Medicine · 年份：2025 · DOI：10.1007/s00134-025-08112-8 · 被引用次数：7 · 研究领域：Atrial Fibrillation Management and Outcomes、Cardiovascular Function and Risk Factors、Cardiac Arrhythmias and Treatments

BACKGROUND: The growing burden of atrial fibrillation (AF) experienced by the general population translates into an increased incidence in the intensive care setting, further aggravated by illness severity. New onset AF has been established as an independent mortality predictor. Cardiology management guidelines are based on major trials that included ambulatory patients with varying degrees of ventricular systolic and diastolic dysfunction, and with variable dependences of left ventricular filling on atrial systole. Emphasis is placed on rate control combined with anticoagulation therapy, along with careful consideration of limiting any myocardial depression by antiarrhythmic medication in patients who often already have some form of structural heart disease. DESIGN: Narrative review Objectives: Critical care echocardiography (CCE) is well established as a widely available diagnostic and monitoring tool in haemodynamically unstable patients. It assists in identifying risk factors associated with arrhythmias, reveals parameters associated with arrhythmia chronicity, and guides therapy to facilitate a return to sinus rhythm. CCE helps guide the crucial management decision to seek either rhythm or rate control and, with rhythm control, monitors return of mechanical sinus rhythm with left atrial recovery post cardioversion. Echocardiography can also help when conflicting management goals are present, such as guideline-driven therapeutic anticoagulation in the intensive care patie...