Der Internist
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Atrial fibrillation is a common and in most patients recurrent arrhythmia. Atrial fibrillation can increase mortality and causes at times severe symptoms in affected patients. Timely initiation of sustained oral anticoagulation is indicated in patients with atrial fibrillation at risk for stroke to prevent thromboembolic complications. ⋯ Other drugs that were not primarily developed as antiarrhythmic agents, e.g., ACE inhibitors, sartans, and possibly statins, can further improve maintenance of sinus rhythm in selected patient groups. Catheter-based isolation of the pulmonary veins is a recently developed intervention that can cure some forms of atrial fibrillation. It is likely that a multimodal therapeutic approach will in the future allow rhythm control therapy to become more effective.
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Acute renal failure is increasingly found in critically ill patients as part of the multiple organ dysfunction syndrome. Intermittent hemodialysis and continuous renal replacement therapy are standard extracorporeal replacement therapies. ⋯ While controlled studies have uniformly shown that a high dose of such replacement therapy increases survival, studies have failed to support a definitive advantage for any method in terms of patient survival. Therefore, the choice of renal replacement therapy should be based on personal experience, the available resources/infrastructure as well as the needs of the individual patient.