Beta-blockers or amiodarone more effective than CCBs in AF patients in ICU: Study

New-onset atrial fibrillation (NOAF) is usually managed by admitting the patients to an intensive care unit (ICU). However, it is generally associated with increased morbidity and mortality.

A systematic scoping review was undertaken by a group of researchers from the United Kingdom to summarise comparative evidence to inform new-onset atrial fibrillation management for patients admitted to ICU.

The researchers searched various databases like MEDLINE, EMBASE, CINAHL, Web of Science, OpenGrey, Cochrane Database of Systematic, EU Clinical Trials register, additional WHO ICTRP trial databases, and NIHR Clinical Trials Gateway, etc. in March 2019.From which they included studies assessing treatment or prevention strategies for new-onset atrial fibrillation management (NOAF) or acute anticoagulation in general medical, surgical or mixed adult ICUs.They collected all the study details, population demographics, intervention and comparator(s), methods addressing confounding, results, and recommendations for future research onto study-specific forms. Finally, out of 3,651 total citations, only 42 articles were eligible. Out of which 25 were primary studies, 12 were review articles and 5 were surveys/opinion papers. Definitions of NOAF varied from NOAF lasting 30 seconds to NOAF lasting greater than 24 hours. Only one comparative study investigated the effects of anticoagulation.

The findings of the study are as follows:

· Proof from small randomized control trials suggest that calcium channel blockers (CCBs) are slower than beta-blockers in rhythm control (1 study), and also cause more cardiovascular instability as compared to amiodarone (1 study).

· While proof from 4 non-randomized studies suggest that beta-blocker and amiodarone therapy may work in a similar fashion concerning rhythm control.

· Beta-blockers may be also tied with reduced mortality as compared to amiodarone, Calcium channel blockers (CCBs), and digoxin, though supporting evidence is subject to confounding.

· Currently, the limited data does not support therapeutic anticoagulation during ICU admission.

The researchers conclude that though the evidence available suggests that beta-blockers or amiodarone may be superior to calcium channel blockers (CCBs) as a primary treatment protocol in undifferentiated patients in ICU; there is not much evidence available to support the use of therapeutic anticoagulation for NOAF in critically ill patients. So, consensus definitions for NOAF, rate, and rhythm control are needed.

Reference:

Treatment strategies for new-onset atrial fibrillation in patients treated on an intensive care unit: a systematic scoping review by Drikite L et. al published in the Critical Care.

https://ccforum.biomedcentral.com/articles/10.1186/s13054-021-03684-5