Atrial Fibrillation

In Atrial fibrillation, the upper chambers of the heart fails to contract normally. The heartbeat is irregular.

Placement in the ICU becomes necessary when heart rate becomes very fast and blood pressure drops.

This means less blood gets pumped to vital organs. Until controlled, the heart usually beats at a dangerously fast rate.

This condition almost always requires transfer to and treatment in the ICU.

Causes of Atrial Fibrillation

Most patients with atrial fibrillation have some other underlying heart disease or chronic pulmonary disease, COPD.

These problems can decrease blood flow to the heart which can then cause the irregular heart beat.

Low blood levels of potassium or magnesium can develop after surgery or from dehydration. These are another cause of the rapid, irregular heart rate of atrial fibrillation.

Heart surgery can irritate it and lead to atrial fibrillation.

There are other causes of; but these listed are the ones that most commonly require ICU care.

Diagnosis of Atrial Fibrillation

The diagnosis of atrial fibrillation can usually be made by looking at the electrocardiogram (EKG) on the bedside monitor.

The top example above show a changing distance between the upward spikes. This is atrial fibrillation

The lower tracing shows a normal heart. The distance between each upward spike is identical.. This is a normal heart rhythm.


The rapid heart rate in atrial fibrillation needs to be slowed to a normal range. This will prevent further and more serious heart damage,

Since the upper part of the heart does not pump much blood. the blood tends to stay in the heart and clots form.

These clots can break off at any time, go to the brain and cause a stroke.

The clots can also move to the intestines, kidneys, other organs or the legs.

Blockage of blood flow to any organ can rapidly lead to temporary or permanent damage. 

Treatment of Atrial Fibrillation

The first action is to slow the heart rate. Medications are rapidly ordered and given continuously by intravenous route.

Sometime several different medications have to be tried before finding one which will work for your loved one.

At the same time, potassium and magnesium are also given intravenously to obtain normal levels.

Rarely, if the drugs don't work quickly enough, the heart may need to be shocked into a normal rhythm.

Patients are given short term sedation for this procedure.

After heart surgery, atrial fibrillation can develop.

Patients usually have wires left on the heart. These are connected to a device which will slow down the rapid heart rate.

Long Term Treatment

After a diagnosis of atrial fibrillation your loved one will usually need to be on medications to prevent blood clots forming in the heart.

These blood thinning medications are necessary to prevent a stroke. They prevent blood clots from forming, breaking loose and go to the brain.

Medications are also started for long term control of heart rate.

Both types of medications will probably be necessary for lifetime.

Current medical evidence suggests that atrial fibrillation with a slow heart rate is as safe as a normal regular heart rate.

The number one goal is to keep the heart rate under control.

Questions to Ask

  • What caused the atrial fibrillation?
  • Will it happen again?
  • Is the atrial fibrillation life threatening?
  • Should the atrial fibrillation be treated to obtain a normal heart rhythm?
  • Will medications work to treat the atrial fibrillation?
  • Why would electricity be used to shock the heart?
  • If the heart needs to be shocked will my loved one be asleep for this?
  • The doctors say an echocardiogram needs to be done first. Why?
  • Is there any risk to doing an echocardiogram?
  • What is the chance of a stroke in someone who has atrial fibrillation?
  • Are medications given to prevent a stroke?
  • How well do the medications work and how long will they be needed? 
  • Will the atrial fibrillation increase hospital or ICU time?