Management of tachyarrhythmias in critically ill patients with sepsisYuri Oishi, Satoru Oku, Naoya Kawanoue, Takako Sasai, Hideyuki Mieda, Yoshiaki Shin, Tomoki Ishikawa, Hiroaki Tokioka Department of Anesthesiology, Okayama Red Cross Hospital 2-1-1 Aoe, Kita-ku, Okayama, Okayama 700-8607, JapanObjectives: Tachyarrhythmias are common in patients with sepsis, which is often associated with cardiac dysfunction, and severe sepsis is one risk factor of new-onset atrial fibrillation (Af). Therefore, management of new-onset Af in patients with sepsis is difficult. In this study, we retrospectively analyzed the incidence, treatment, and outcome of tachyarrhythmias in patients with sepsis. Methods: This study included patients with sepsis admitted to our ICU over a period of five years. We excluded patients who had an ICU stay within 24 hours, a history of Af, trauma, patients undergoing blood purification therapy and those with other confounding factors. We classified those with a heart rate over 130 /min as having tachyarrhythmia. Results: A total of 147 patients were included in this study. Tachyarrhythmias were detected in 63 patients (43%). The patients with tachyarrhythmias were significantly older, had higher Acute Physiology and Chronic Health Evaluation II (APACHE II ) scores, greater use of noradrenaline, milrinone, and showed higher in-hospital mortality than those without tachyarrhythmias. Our management of Af is based on administration of digoxin and landiolol. Sinus rhythm was successfully restored in 90% of the patients. Patients in whom sinus rhythm was not achieved had higher ICU mortality than those in whom it was achieved. Conclusions: Tachyarrhythmias occurred in 43% of patients with sepsis, and patients with tachyarrhythmias had higher in-hospital mortality. Ninety percent of Af were returned to sinus rhythm by administration of digoxin and landiolol.