Propafenone for supraventricular arrhythmias in septic shock—Comparison to amiodarone and metoprolol

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Purpose:The occurence of supraventricular arrhythmias associate with an unfavourable prognosis in septic shock. Propafenone could be a feasible antiarrhythmic.Materials and methods:Patients collected over a period of 24 months were divided into the three groups based on antiarrhythmic: Group1(amiodarone), Group2(propafenone), Group3(metoprolol). Type of arrhythmia, cardioversion rates, demographic, haemodynamic, laboratory parameters were recorded in the first 24 h. The outcome data were compared between the groups.Results:234 patients (99.1% ventilated) were included, the prevailing arrhythmia was acute onset atrial fibrillation (AF,69.7%). Except for the dosage of noradrenaline (0.35(0.14–0.78) in Group1(n = 142)vs 0.25(0.10–0.50),p < 0.01 in Group2(n = 78)vs 0.14(0.07–0.25)μg/kg·min,p < 0.05 in Group3(n = 14)) the ejection fraction of left ventricle, rates of renal replacement therapy, arterial lactate and procalcitonin levels were not different between the groups. The cardioversion rate in Group1(74%) was lower than in Group2(89%) and Group3(92%). ICU and 28-day mortalities of Group1 were not significantly higher than in Group2 and Group3. Multivariate analysis demonstrated higher 12-month mortality in Group1 than in Group2 (HR1.58(1.04;2.38),p = 0.03).Conclusions:Propafenone demonstrated a higher cardioversion rate than amiodarone with a similar impact on the outcome. Patients remaining in acute onset arrhythmia did not demonstrate significantly higher ICU, 28-day and 12-month mortalities compared to those successfully cardioverted or to those having chronic AF.HIGHLIGHTSAn acute onset SV arrhythmia increases mortality in the septic shock patients.Propafenon is feasible if given within the current summary of product characteristics.Propafenone is more efficient than amiodarone to cardiovert a SV arrhythmia.Propafenon is at least as safe as amiodarone in relation to the outcome.Cardioverting an acute onset SV arrhythmia may have a positive impact on mortality.

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