Do we need an individual approach to atrial fibrillation and adrenergic overload in the critically ill?

Despite catecholamines being lifesaving drugs, they can also be harmful. Adrener-gic overload is one of the major causes of supra- and ventricular arrhythmias, which induce haemodynamic instability of criti-cally ill patients. In this paper we will focus on the pathophysiology of atrial fibrillation (AF), the importance of adrenergic over-load for triggering AF, the importance of the autonomic nervous system and we will challenge the importance of decreasing adrenergic load with selective and non-selective β-blockers, which have different effects on the metabolism of the severely ill. We will also emphasize the importance of an individual approach due to pharma-cogenetic differences in β-adrenergic sig-nalling.  

catecholamines, atrial fibrilla-tion, beta-blockers, metabolism, resting en-ergy expenditure

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