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. 2022 Jun 13;24(Suppl D):D3-D10.
doi: 10.1093/eurheartjsupp/suac022. eCollection 2022 Jun.

Acute rate control in atrial fibrillation: an urgent need for the clinician

Gheorghe-Andrei Dan  1 , Anca R Dan  2 , Andreea Ivanescu  1 , Adrian C Buzea  1
Affiliations

Acute rate control in atrial fibrillation: an urgent need for the clinician

Gheorghe-Andrei Dan et al. Eur Heart J Suppl. .

Abstract

Rate and rhythm control are still considered equivalent strategies for symptom control using the Atrial Fibrillation Better Care algorithm recommended by the recent atrial fibrillation guideline. In acute situations or critically ill patients, a personalized approach should be used for rapid rhythm or rate control. Even though electrical cardioversion is generally indicated in haemodynamically unstable patients or for rapid effective rhythm control in critically ill patients, this is not always possible due to the high percentage of failure or relapses in such patients. Rate control remains the background therapy for all these patients, and often rapid rate control is mandatory. Short and rapid-onset-acting beta-blockers are the most suitable drugs for acute rate control. Esmolol was the classical example; however, landiolol a newer very selective beta-blocker, recently included in the European atrial fibrillation guideline, has a more favourable pharmacokinetic and pharmacodynamic profile with less haemodynamic interference and is better appropriate for critically ill patients.

Keywords: ABC; Acute rate control; Atrial fibrillation; Critically ill patients; Heart failure; Landiolol.

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Figures

Figure 1
Figure 1
Proposed algorithm for rate and rhythm control in acute, critically ill, or postoperative patients. If acute rate control is inefficient, electrical cardioversion should be attempted (dotted line). Ad: amiodarone; BB: beta-blockers; Dx: Digoxin/Digitoxin. *Anticoagulation following guideline recommendation. **ABC: Atrial Fibrillation Better Care algorithm (see text).
See this image and copyright information in PMC

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