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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Wednesday, November 18, 2015

Fibrilación auricular reciente estable (NAFCI)

PulmCrit - November 9, 2015 - By Josh Farkas
NAFCI is used here to refer to patients with no prior history of AF who are admitted in sinus rhythm and subsequently develop new-onset AF while being treated for critical illness, generally in the ICU. The main differential diagnostic consideration is previously undiagnosed asymptomatic paroxysmal AF. Features that would support a diagnosis of NAFCI rather than chronic, paroxysmal AF may include symptomatic AF or severe physiologic stress triggering transition into AF (e.g. AF immediately following an epinephrine bolus). 
NAFCI is common in critically ill patients with an incidence of ~10%, but little is known about its treatment (Yoshida 2015). Unfortunately, our understanding of AF treatment is based almost exclusively on studies of outpatients with chronic, recurrent AF occurring spontaneously - which is the polar opposite of NAFCI.
  • New-onset AF is common among critically ill patients, but very little is known about its treatment.
  • New-onset AF correlates with increased stroke rate, ICU length of stay, and mortality. However, it is unknown whether AF causes increased mortality. 
  • Theoretical arguments favoring an attempt at rhythm control include improved cardiac function, reduced stroke risk, and reduced risk of persistent AF. 
  • Combining magnesium and amiodarone yields a high rate of cardioversion among new-onset AF. 
  • Although amiodarone has substantial long-term toxicity, short courses of intravenous amiodarone are well tolerated.