Management of tachyarrhythmias in critically ill patients with sepsis

Abstract

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.

Landiolol for Treatment of New-Onset Atrial Fibrillation in Critical Care: A Systematic Review

“…One additional publication provided data on cardioversion for both surgical and non-surgical settings. Overall, ten surgical studies (two pulmonary surgical studies [13,14], six esophagectomy studies [15][16][17][18][19][20], two studies on other surgeries [21,22], and one unspecified surgical study [23]), six non-surgical studies (four sepsis studies [24][25][26][27], one septic shock study [28], and one SIRS study [29]), and one mixed ICU study [21] were included. The total number of patients treated with landiolol was 103 for the non-surgical setting and 221 for the surgical setting.…”

“…The rate of conversion of NOAF to sinus rhythm was similar in non-surgical and surgical patients, ranging from 50% to 100% (mean, 75.7%) and from 47% to 100% (mean, 70.1%), respectively (Figures 2 and 3). In most publications, the timing of the conversion to sinus rhythm was reported, with six studies [14,16,17,22,23,28] providing mean conversion times ranging from 1.8 h to 9.1 h. Additionally, five studies [13,18,[24][25][26] presented conversion rates at 12 h or 24 h. Notably, detailed timing data revealed that the majority of patients converted within 12 h [13,14,16,18,24]. Landiolol treatment consistently resulted in a rapid and substantial reduction in heart rate with minimal impact on blood pressure.…”

“…Twelve studies [13][14][15][16][17][18][19]21,22,24,26] provided data on the heart rate decrease, which ranged from −18% to −51% from baseline. Three additional studies [19,23,25,28] reported the percentage of patients achieving a heart rate target below 100 bpm (see Table 2). In studies with a control group, patients treated with landiolol exhibited an accelerated reduction in heart rate [14,16,24,27].…”