Use of Amiodarone in Management of Atrial Tachyarrhythmia in Septic Shock

Jaffer, Faraz; Anand, S.; Ajay-obe, Akinbola; Parbtani, R.; Doraiswamy, Vijay; Malo, Joshua

doi:10.1016/j.chest.2016.08.374

Cited by 4 publications

(28 citation statements)

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“…Thirty-six studies reported on the incidence of AF (Table 2). 16, 17, 22–55 One study was published in Hebrew, while all others were in English. Twenty-three studies evaluated patients in an ICU, and 13 studies evaluated patients in a hospital ward setting.…”

Section: Resultsmentioning

confidence: 99%

Atrial fibrillation detected initially during acute medical illness: A systematic review

McIntyre

Cheung

et al. 2018

European Heart Journal: Acute Cardiovascular Care

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Objective: There is uncertainty about the incidence of and prognosis associated with atrial fibrillation that is documented for the first time in the setting of an acute stressor, such as surgery or medical illness. Our objective was to perform a systematic review of the incidence and long-term recurrence rates for atrial fibrillation occurring transiently with stress in the setting of acute medical illness. Data sources: Medline, Embase and Cochrane Central to September 2017. Study selection: We included retrospective and prospective observational studies, and randomised controlled trials. The population of interest included patients hospitalised for medical (i.e. non-surgical) illness who developed newly diagnosed atrial fibrillation. Studies were included if they included data on either the incidence of atrial fibrillation or the rate of atrial fibrillation recurrence in atrial fibrillation occurring transiently with stress patients following hospital discharge. Data extraction: Two reviewers collected data independently and in duplicate. We characterised each study’s methodology for ascertainment of prior atrial fibrillation history, atrial fibrillation during hospitalisation and atrial fibrillation recurrence after hospital discharge. Data synthesis: Thirty-six studies reported the incidence of atrial fibrillation. Ten used a prospective design and included a period of continuous electrocardiographic (ECG) monitoring. Atrial fibrillation incidence ranged from 1% to 44%, which was too heterogeneous to justify meta-analysis ( I2=99%). In post-hoc meta-regression models, the use of continuous ECG monitoring explained 13% of the variance in atrial fibrillation incidence, while care in an intensive care unit explained none. Two studies reported the long-term rate of atrial fibrillation recurrence following atrial fibrillation occurring transiently with stress. Neither of these studies used prospective, systematic monitoring. Recurrence rates at 5 years ranged from 42% to 68%. Conclusions: The incidence of atrial fibrillation with medical illness may be as high as 44%, with higher estimates in reports using continuous ECG monitoring. Within 5 years following hospital discharge, atrial fibrillation recurrence is documented in approximately half of patients; however, the true rate may be higher. Protocol registration PROSPERO CRD42016043240

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Section: Resultsmentioning

confidence: 99%

Atrial fibrillation detected initially during acute medical illness: A systematic review

McIntyre

Cheung

et al. 2018

European Heart Journal: Acute Cardiovascular Care

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“…After full text screening, 42 articles were included in the review: 25 primary studies, 12 review articles and 5 surveys/opinion papers. Of the 25 primary studies, two RCTs [22,23] two prospective comparative studies [24,25], nine retrospective comparative studies [26][27][28][29][30][31][32][33][34] and 12 non-comparative studies [5,[35][36][37][38][39][40][41][42][43][44][45] were included. Six studies [27-30, 32, 39] were available only as conference abstracts.…”

Section: Search Resultsmentioning

confidence: 99%

“…Five studies [ 5 , 23 , 38 , 42 , 45 ] were conducted in mixed ICUs and one study [ 26 ] in a general ICU. The type of ICU was not specified in 10 studies [ 25 , 28 – 30 , 32 – 34 , 36 , 39 , 40 ]. Eleven studies included patients with sepsis [ 5 , 27 , 28 , 33 – 35 , 38 , 43 ] or septic shock [ 25 , 26 , 29 ] as primary diagnoses.…”

Section: Resultsmentioning

confidence: 99%

“…The type of ICU was not specified in 10 studies [ 25 , 28 – 30 , 32 – 34 , 36 , 39 , 40 ]. Eleven studies included patients with sepsis [ 5 , 27 , 28 , 33 – 35 , 38 , 43 ] or septic shock [ 25 , 26 , 29 ] as primary diagnoses. Four studies [ 22 , 24 , 31 , 41 ] were conducted in a noncardiac surgical population.…”

Section: Resultsmentioning

confidence: 99%

“…Most studies and review articles that were included in this review concluded that further prospective research accounting for confounding factors is required to determine the success and clinical implications of prophylactic and treatment strategies in patients treated in an ICU with NOAF [5,6,14,22,24,25,28,29,32,33,38,40,41,43,[46][47][48][49][50][51][52]. It was emphasised that optimal regimens and best dosing strategies for treatments are yet to be established [31,37,45].…”

Section: Reported Recommendations For Future Researchmentioning

confidence: 99%

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Treatment strategies for new onset atrial fibrillation in patients treated on an intensive care unit: a systematic scoping review

et al. 2021

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Background New-onset atrial fibrillation (NOAF) in patients treated on an intensive care unit (ICU) is common and associated with significant morbidity and mortality. We undertook a systematic scoping review to summarise comparative evidence to inform NOAF management for patients admitted to ICU. Methods We searched MEDLINE, EMBASE, CINAHL, Web of Science, OpenGrey, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, ISRCTN, ClinicalTrials.gov, EU Clinical Trials register, additional WHO ICTRP trial databases, and NIHR Clinical Trials Gateway in March 2019. We included studies evaluating treatment or prevention strategies for NOAF or acute anticoagulation in general medical, surgical or mixed adult ICUs. We extracted study details, population characteristics, intervention and comparator(s), methods addressing confounding, results, and recommendations for future research onto study-specific forms. Results Of 3,651 citations, 42 articles were eligible: 25 primary studies, 12 review articles and 5 surveys/opinion papers. Definitions of NOAF varied between NOAF lasting 30 s to NOAF lasting > 24 h. Only one comparative study investigated effects of anticoagulation. Evidence from small RCTs suggests calcium channel blockers (CCBs) result in slower rhythm control than beta blockers (1 study), and more cardiovascular instability than amiodarone (1 study). Evidence from 4 non-randomised studies suggests beta blocker and amiodarone therapy may be equivalent in respect to rhythm control. Beta blockers may be associated with improved survival compared to amiodarone, CCBs, and digoxin, though supporting evidence is subject to confounding. Currently, the limited evidence does not support therapeutic anticoagulation during ICU admission. Conclusions From the limited evidence available beta blockers or amiodarone may be superior to CCBs as first line therapy in undifferentiated patients in ICU. The little evidence available does not support therapeutic anticoagulation for NOAF whilst patients are critically ill. Consensus definitions for NOAF, rate and rhythm control are needed.

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New-onset atrial fibrillation in adult critically ill patients: a scoping review

et al. 2019

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Use of Amiodarone in Management of Atrial Tachyarrhythmia in Septic Shock

Cited by 4 publications

References 0 publications

Atrial fibrillation detected initially during acute medical illness: A systematic review

Atrial fibrillation detected initially during acute medical illness: A systematic review

Treatment strategies for new onset atrial fibrillation in patients treated on an intensive care unit: a systematic scoping review

New-onset atrial fibrillation in adult critically ill patients: a scoping review

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