Do we need an individual approach to atrial fibrillation and adrenergic overload in the critically ill?

Abstract

Despite catecholamines being lifesaving drugs, they can also be harmful. Adrenergic overload is one of the major promoters of supra-and ventricular arrhythmias, which induce hemodynamic instability in the critically ill. In this paper we will focus on the pathophysiology of atrial fibrillation (AF), the importance of adrenergic overload for triggering AF, the importance of the auto-nomic nervous system and finally, we will challenge the importance of decreasing adrenergic load with selective and non-selective β-blockers, which have different effects on the metabolism in the severely ill. We will also emphasize the importance of an individual approach due to pharma-cogenetic differences in β-adrenergic sig-nalling.