Atrial arrhythmia in the Intensive Care Unit

A 72-year-old man was admitted because of cardiogenic shock due to acute anterior myocardial infarction with ST-segment elevation. Percutaneous coronary intervention was performed with stenting of the occluded proximal left anterior descending artery with two sirolimus-eluting stents and placement of intra-aortic balloon pump. Mechanical ventilation and haemodynamic support with dobutamine and norepinephrine were required. Later on, anti-arrhythmic therapy with amiodarone was needed because of atrial fibrillation. Only after electrical cardioversion sinus rhythm was reestablished. In sustained low output heart failure dobutamine was replaced by levosimendan (Simdax®). Furthermore, renal replacement therapy was started because of progressive renal failure. During continuous venovenous haemofiltration (Cobe Prisma system®), Gambro Healthcare, USA) the patient developed an apparent atrial flutter with variable atrioventricular conduction (fig. 1). Is this the correct diagnosis?