Do we need an individual approach to atrial fibrillation and adrenergic overload in the critically ill?
1University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
2 Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Slovenia
3 Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nuernberg-Paracelsus Medical University, Nuremberg, Germany
4 Clinical Department for Anaesthesiology and Surgical Intensive Care, University Medical Centre Ljubljana, Slovenia
DOI: 10.22514/SV141.042018.9 Vol.14,Issue 1,March 2018 pp.53-58
Published: 27 March 2018
Despite catecholamines being lifesaving drugs, they can also be harmful. Adrenergic overload is one of the major promoters of supra- and ventricular arrhythmias, which induce hemodynamic instability in the crit-ically ill. In this paper we will focus on the pathophysiology of atrial fibrillation (AF), the importance of adrenergic overload for triggering AF, the importance of the auto-nomic nervous system and finally, we will challenge the importance of decreasing adrenergic load with selective and non-selective β-blockers, which have different effects on the metabolism in the severely ill. We will also emphasize the importance of an individual approach due to pharma-cogenetic differences in β-adrenergic sig-nalling.
catecholamine, atrial fibrillation, beta-blocker, metabolism, resting energy ex-penditure
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