Impact of metabolic interventions on atrial fibrillation during critical illness: focus on tight glucose control with insulin and early macronutrient availability.

Atrial fibrillation (AF) is a very common and clinically relevant problem during critical illness. Current treatment strategies are symptomatic and don’t primarily address underlying etiology. Inflammation and oxidative stress are well recognized triggers for AF induction, while changes in atrial metabolism are increasingly recognized in its pathogenesis. Tight glucose control with insulin has been shown to reduce both inflammation and oxidative stress, and is very likely to interfere with atrial metabolism, hence simultaneously interacts with multiple pathways shown to be involved in AF pathogenesis. We hereby hypothesize therapeutic potential of tight glucose control with insulin as a clinically feasible, safe and powerful strategy to reduce AF burden during critical illness.