Réanimation

, Volume 21, Issue 2, pp 180–187

Traitement de la fibrillation atriale en réanimation (hors anticoagulation)

Mise au Point / Update
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Résumé

La fibrillation atriale (FA) est le trouble du rythme le plus communément observé en réanimation. Elle est souvent favorisée par des facteurs extracardiaques tels que l’hypoxie, le sepsis, l’inflammation et certains troubles hydroélectrolytiques. Les complications thromboemboliques et hémodynamiques qu’elle entraîne sont bien connues, mais son impact sur la mortalité n’est pas démontré. La prise en charge d’une FA repose sur deux stratégies distinctes: le ralentissement et la conversion. Peu de données sont actuellement disponibles pour déterminer la place de l’une ou de l’autre en réanimation. Avec la cardioversion électrique, les antiarythmiques de classes III et Ic peuvent être utilisés pour obtenir le retour en rythme sinusal, mais leur efficacité et leur innocuité sont peu documentées en réanimation. De nouvelles molécules aux propriétés arythmogènes limitées ont été développées ces dernières années, sans que l’on puisse encore les recommander en pratique courante. Le ralentissement d’une FA est classiquement obtenu à l’aide de bêtabloquants, d’inhibiteurs calciques, de la digoxine ou de l’amiodarone. Le but de cet article est de passer en revue les thérapeutiques disponibles pour la conversion ou le ralentissement d’une FA en réanimation.

Mots clés

Fibrillation atriale Cardioversion Réanimation Antiarythmiques 

Treatment of atrial fibrillation in ICU (apart from anticoagulation)

Abstract

Atrial fibrillation (AF) is the most common arrhythmia encountered in acutely ill patients. AF is partly triggered by non-cardiac factors such as hypoxia, sepsis, inflammation or ionic abnormalities. AF can lead to haemodynamic instability and thromboembolism, although its impact on mortality has not been clearly determined. AF management includes two distinct strategies based on heart rate and rhythm control. Data are too scarce to determine the most appropriate one in the critical care setting. Apart from direct current cardioversion, class III (and Ic) antiarrhythmics are commonly used to reverse AF to sinus rhythm; however, only few data are available on their usefulness and reliability in critically ill patients. In recent years, new agents with fewer proarrhythmic effects have been developed, but data are still lacking to recommend their use. Betablockers, calcium blockers, digoxin, and amiodarone may be used to control heart rate. The aim of this article is to provide an overview of the therapeutics used for AF cardioversion and rate control in the critical care setting.

Keywords

Atrial fibrillation Cardioversion Critical illness Antiarrythmics 

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Copyright information

© Société de réanimation de langue française (SRLF) and Springer-Verlag France 2012

Authors and Affiliations

  1. 1.Service de réanimation médicochirurgicalehôpital René-DubosPontoiseFrance
  2. 2.Service de réanimation chirurgicaleCHU PontchaillouRennesFrance

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