open access

Vol 49, No 5 (2017)
Review articles
Published online: 2017-11-18
Submitted: 2017-09-15
Accepted: 2017-11-11
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Management of arrhythmia in sepsis and septic shock

Martin Balik, Vojtech Matousek, Michal Maly, Tomas Brozek
DOI: 10.5603/AIT.a2017.0061
·
Pubmed: 29151002
·
Anaesthesiol Intensive Ther 2017;49(5):419-429.

open access

Vol 49, No 5 (2017)
Review articles
Published online: 2017-11-18
Submitted: 2017-09-15
Accepted: 2017-11-11

Abstract

The occurrence of supraventricular arrhythmias is associated with an unfavourable prognosis in septic shock. Available trials are difficult to apply in sepsis and septic shock patients due to included cohorts, control groups and because “one size does not fit all“. The priorities in the critically ill are maintenance of the sinus rhythm and diastolic ventricular filling. The rate control modality should be reserved for chronic AF and in situations when the sinus rhythm is difficult to maintain due to extreme stress conditions resulting from a high dosage of vasoactive agents. Electric cardioversion is indicated in unstable patients with an absence of contraindications and is more feasible in combination with an antiarrhythmic agent. Besides amiodarone being preferred for its lower cardiodepressant side effect compared to other agents, drugs with a different degree of betablocking activity are very useful in supraventricular arrhythmias and septic shock, providing echocardiography is routinely used to support their indications within the current summary of product characteristics. A typical patient benefiting from propafenone is without significant structural heart disease, i.e. typically with normal to moderately reduced left ventricular systolic function. Future research should be channelled towards echocardiography-guided prospective controlled trials on antiarrhythmic therapy which may clarify the issue of rhythm versus rate control, the effects of various antiarrhythmic drugs, and a place for electric cardioversion in critically ill patients in septic shock.

Abstract

The occurrence of supraventricular arrhythmias is associated with an unfavourable prognosis in septic shock. Available trials are difficult to apply in sepsis and septic shock patients due to included cohorts, control groups and because “one size does not fit all“. The priorities in the critically ill are maintenance of the sinus rhythm and diastolic ventricular filling. The rate control modality should be reserved for chronic AF and in situations when the sinus rhythm is difficult to maintain due to extreme stress conditions resulting from a high dosage of vasoactive agents. Electric cardioversion is indicated in unstable patients with an absence of contraindications and is more feasible in combination with an antiarrhythmic agent. Besides amiodarone being preferred for its lower cardiodepressant side effect compared to other agents, drugs with a different degree of betablocking activity are very useful in supraventricular arrhythmias and septic shock, providing echocardiography is routinely used to support their indications within the current summary of product characteristics. A typical patient benefiting from propafenone is without significant structural heart disease, i.e. typically with normal to moderately reduced left ventricular systolic function. Future research should be channelled towards echocardiography-guided prospective controlled trials on antiarrhythmic therapy which may clarify the issue of rhythm versus rate control, the effects of various antiarrhythmic drugs, and a place for electric cardioversion in critically ill patients in septic shock.
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Keywords

septic shock, supraventricular arrhythmia, atrial fibrillation, propafenone, amiodarone, metoprolol, esmolol, betablockers, electric cardioversion

About this article
Title

Management of arrhythmia in sepsis and septic shock

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 49, No 5 (2017)

Pages

419-429

Published online

2017-11-18

DOI

10.5603/AIT.a2017.0061

Pubmed

29151002

Bibliographic record

Anaesthesiol Intensive Ther 2017;49(5):419-429.

Keywords

septic shock
supraventricular arrhythmia
atrial fibrillation
propafenone
amiodarone
metoprolol
esmolol
betablockers
electric cardioversion

Authors

Martin Balik
Vojtech Matousek
Michal Maly
Tomas Brozek

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