Year: 2026
Type: editorial
Abstract: Cardiac arrhythmias become frequent in general population which transmits to the incidence among the critically ill. (1) As an independent mortality predictor, they represent either a primary problem or consequence of the underlying critical illness and an important driver of further hemodynamic deterioration. (2,3) The evidence in critical care arrhythmia management is limited because some of the conclusions generated on large cohorts of cardiology outpatients cannot be applied in the acute and intensive care setting. Hence, the decisions are often driven by available bedside imaging and applied physiology. (4) Shortened diastolic filling, loss of atrial contribution, irregular ventricular activation, increased myocardial oxygen demand, reduced coronary perfusion, and impaired ventricular function may all contribute to a rapid decline in cardiac output, particularly in patients with pre-existing ventricular dysfunction or limited cardiovascular reserve. (5,6) The resulting hypotension and congestion, sympathetic activation and myocardial ischemia in turn facilitate recurrent arrhythmia. Thus, a self-perpetuating cycle may develop in which arrhythmia aggravates hemodynamic compromise, while hemodynamic and metabolic deterioration further increases arrhythmogenicity. (5)(6)(7) Potentially reversible precipitants-including acute myocardial ischemia, electrolyte abnormalities, acidosis, hypoxemia, elevated filling pressure, infection, drug toxicity, and proarrhythmic medication-must be identified and corrected simultaneously.
Authors: Martin Balik, Stepan Havranek
Institutions: Charles University, General University Hospital in Prague
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7223849709