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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
*Corresponding Author(s): MATEJ PODBREGAR E-mail: matej.podbregar@guest.arnes.si
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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