Propafenone versus amiodarone for supraventricular arrhythmias in septic shock: a randomised controlled trial
Purpose Acute onset supraventricular arrhythmias can contribute to haemodynamic compromise in septic shock. Both amiodarone and propafenone are available interventions, but their clinical effects have not yet been directly compared. Methods In this two-centre, prospective controlled parallel group d...
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| Veröffentlicht in: | Intensive care medicine 2023-11, Vol.49 (11), p.1283-1292 |
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| creator | Balik, Martin Maly, Michal Brozek, Tomas Rulisek, Jan Porizka, Michal Sachl, Robert Otahal, Michal Brestovansky, Petr Svobodova, Eva Flaksa, Marek Stach, Zdenek Horejsek, Jan Volny, Lukas Jurisinova, Ivana Novotny, Adam Trachta, Pavel Kunstyr, Jan Kopecky, Petr Tencer, Tomas Pazout, Jaroslav Belohlavek, Jan Duska, Frantisek Krajcova, Adela Waldauf, Petr |
| description | Purpose
Acute onset supraventricular arrhythmias can contribute to haemodynamic compromise in septic shock. Both amiodarone and propafenone are available interventions, but their clinical effects have not yet been directly compared.
Methods
In this two-centre, prospective controlled parallel group double blind trial we recruited 209 septic shock patients with new-onset arrhythmia and a left ventricular ejection fraction above 35%. The patients were randomised in a 1:1 ratio to receive either intravenous propafenone (70 mg bolus followed by 400–840 mg/24 h) or amiodarone (300 mg bolus followed by 600–1800 mg/24 h). The primary outcomes were the proportion of patients who had sinus rhythm 24 h after the start of the infusion, time to restoration of the first sinus rhythm and the proportion of patients with arrhythmia recurrence.
Results
Out of 209 randomized patients, 200 (96%) received the study drug. After 24 h, 77 (72.8%) and 71 (67.3%) were in sinus rhythm (
p
= 0.4), restored after a median of 3.7 h (95% CI 2.3–6.8) and 7.3 h (95% CI 5–11),
p
= 0.02, with propafenone and amiodarone, respectively. The arrhythmia recurred in 54 (52%) patients treated with propafenone and in 80 (76%) with amiodarone,
p |
| doi_str_mv | 10.1007/s00134-023-07208-3 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_2864156974</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A771278113</galeid><sourcerecordid>A771278113</sourcerecordid><originalsourceid>FETCH-LOGICAL-c480t-e46c52b4cb907e6eb439c08ef3e43656b702a01733dda5b35c1139fd3e13786d3</originalsourceid><addsrcrecordid>eNp9kk1rFTEUhoMo9rb6B1xIwI2bqfmaJOOulPoBBV3oOmQyZ-5NzSRjMlPov2-ut1qUi2SRcPK8L-ccXoReUXJOCVHvCiGUi4Yw3hDFiG74E7ShgrOGMq6fog3hgjVCCnaCTku5qbiSLX2OTriSnW47sUHT15xmO0JMEfAt5LIWbCefBpv3lTFlXNY521uIS_ZuDTZjm_PubtlN3hbsIy4wL97hskvux3tscbZxSJMvMGCXqiqFUJ9VbcML9Gy0ocDLh_sMff9w9e3yU3P95ePny4vrxglNlgaEdC3rhes7okBCL3jniIaRg-Cylb0izNZhOB8G2_a8dZTybhw4UK60HPgZenvwnXP6uUJZTO3HQQg2QlqLYVoK2spOiYq--Qe9SWuOtbtK6ZZrphl5pLY2gPFxTEu2bm9qLpSiTOnaQaWaI9QWImQb6jpHX8t_8edH-HoGmLw7KmAHgcuplAyjmbOfbL4zlJh9JswhE6ZmwvzKhNmLXj9MuPYTDH8kv0NQAX4ASv2KW8iPK_iP7T1x1MDq</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2885382820</pqid></control><display><type>article</type><title>Propafenone versus amiodarone for supraventricular arrhythmias in septic shock: a randomised controlled trial</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Balik, Martin ; Maly, Michal ; Brozek, Tomas ; Rulisek, Jan ; Porizka, Michal ; Sachl, Robert ; Otahal, Michal ; Brestovansky, Petr ; Svobodova, Eva ; Flaksa, Marek ; Stach, Zdenek ; Horejsek, Jan ; Volny, Lukas ; Jurisinova, Ivana ; Novotny, Adam ; Trachta, Pavel ; Kunstyr, Jan ; Kopecky, Petr ; Tencer, Tomas ; Pazout, Jaroslav ; Belohlavek, Jan ; Duska, Frantisek ; Krajcova, Adela ; Waldauf, Petr</creator><creatorcontrib>Balik, Martin ; Maly, Michal ; Brozek, Tomas ; Rulisek, Jan ; Porizka, Michal ; Sachl, Robert ; Otahal, Michal ; Brestovansky, Petr ; Svobodova, Eva ; Flaksa, Marek ; Stach, Zdenek ; Horejsek, Jan ; Volny, Lukas ; Jurisinova, Ivana ; Novotny, Adam ; Trachta, Pavel ; Kunstyr, Jan ; Kopecky, Petr ; Tencer, Tomas ; Pazout, Jaroslav ; Belohlavek, Jan ; Duska, Frantisek ; Krajcova, Adela ; Waldauf, Petr</creatorcontrib><description>Purpose
Acute onset supraventricular arrhythmias can contribute to haemodynamic compromise in septic shock. Both amiodarone and propafenone are available interventions, but their clinical effects have not yet been directly compared.
Methods
In this two-centre, prospective controlled parallel group double blind trial we recruited 209 septic shock patients with new-onset arrhythmia and a left ventricular ejection fraction above 35%. The patients were randomised in a 1:1 ratio to receive either intravenous propafenone (70 mg bolus followed by 400–840 mg/24 h) or amiodarone (300 mg bolus followed by 600–1800 mg/24 h). The primary outcomes were the proportion of patients who had sinus rhythm 24 h after the start of the infusion, time to restoration of the first sinus rhythm and the proportion of patients with arrhythmia recurrence.
Results
Out of 209 randomized patients, 200 (96%) received the study drug. After 24 h, 77 (72.8%) and 71 (67.3%) were in sinus rhythm (
p
= 0.4), restored after a median of 3.7 h (95% CI 2.3–6.8) and 7.3 h (95% CI 5–11),
p
= 0.02, with propafenone and amiodarone, respectively. The arrhythmia recurred in 54 (52%) patients treated with propafenone and in 80 (76%) with amiodarone,
p
< 0.001. Patients with a dilated left atrium had better rhythm control with amiodarone (6.4 h (95% CI 3.5; 14.1) until cardioversion vs 18 h (95% CI 2.8; 24.7) in propafenone,
p
= 0.05).
Conclusion
Propafenone does not provide better rhythm control at 24 h yet offers faster cardioversion with fewer arrhythmia recurrences than with amiodarone, especially in patients with a non-dilated left atrium. No differences between propafenone and amiodarone on the prespecified short- and long-term outcomes were observed.</description><identifier>ISSN: 0342-4642</identifier><identifier>EISSN: 1432-1238</identifier><identifier>DOI: 10.1007/s00134-023-07208-3</identifier><identifier>PMID: 37698594</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Amiodarone ; Amiodarone - therapeutic use ; Anesthesiology ; Anti-Arrhythmia Agents - therapeutic use ; Arrhythmia ; Atrial Fibrillation - therapy ; Cardiac arrhythmia ; Cardiac patients ; Cardioversion ; Critical Care Medicine ; Drug delivery systems ; Drug therapy ; Emergency Medicine ; Encainide hydrochloride ; Heart ; Hemodynamics ; Humans ; Intensive ; Medicine ; Medicine & Public Health ; Original ; Pain Medicine ; Pediatrics ; Pneumology/Respiratory System ; Propafenone - therapeutic use ; Prospective Studies ; Rhythm ; Sepsis ; Septic shock ; Shock, Septic - complications ; Shock, Septic - drug therapy ; Sinuses ; Stroke Volume ; Ventricle ; Ventricular Function, Left</subject><ispartof>Intensive care medicine, 2023-11, Vol.49 (11), p.1283-1292</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. Springer-Verlag GmbH Germany, part of Springer Nature.</rights><rights>COPYRIGHT 2023 Springer</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c480t-e46c52b4cb907e6eb439c08ef3e43656b702a01733dda5b35c1139fd3e13786d3</citedby><cites>FETCH-LOGICAL-c480t-e46c52b4cb907e6eb439c08ef3e43656b702a01733dda5b35c1139fd3e13786d3</cites><orcidid>0000-0003-1864-2143</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00134-023-07208-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00134-023-07208-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37698594$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Balik, Martin</creatorcontrib><creatorcontrib>Maly, Michal</creatorcontrib><creatorcontrib>Brozek, Tomas</creatorcontrib><creatorcontrib>Rulisek, Jan</creatorcontrib><creatorcontrib>Porizka, Michal</creatorcontrib><creatorcontrib>Sachl, Robert</creatorcontrib><creatorcontrib>Otahal, Michal</creatorcontrib><creatorcontrib>Brestovansky, Petr</creatorcontrib><creatorcontrib>Svobodova, Eva</creatorcontrib><creatorcontrib>Flaksa, Marek</creatorcontrib><creatorcontrib>Stach, Zdenek</creatorcontrib><creatorcontrib>Horejsek, Jan</creatorcontrib><creatorcontrib>Volny, Lukas</creatorcontrib><creatorcontrib>Jurisinova, Ivana</creatorcontrib><creatorcontrib>Novotny, Adam</creatorcontrib><creatorcontrib>Trachta, Pavel</creatorcontrib><creatorcontrib>Kunstyr, Jan</creatorcontrib><creatorcontrib>Kopecky, Petr</creatorcontrib><creatorcontrib>Tencer, Tomas</creatorcontrib><creatorcontrib>Pazout, Jaroslav</creatorcontrib><creatorcontrib>Belohlavek, Jan</creatorcontrib><creatorcontrib>Duska, Frantisek</creatorcontrib><creatorcontrib>Krajcova, Adela</creatorcontrib><creatorcontrib>Waldauf, Petr</creatorcontrib><title>Propafenone versus amiodarone for supraventricular arrhythmias in septic shock: a randomised controlled trial</title><title>Intensive care medicine</title><addtitle>Intensive Care Med</addtitle><addtitle>Intensive Care Med</addtitle><description>Purpose
Acute onset supraventricular arrhythmias can contribute to haemodynamic compromise in septic shock. Both amiodarone and propafenone are available interventions, but their clinical effects have not yet been directly compared.
Methods
In this two-centre, prospective controlled parallel group double blind trial we recruited 209 septic shock patients with new-onset arrhythmia and a left ventricular ejection fraction above 35%. The patients were randomised in a 1:1 ratio to receive either intravenous propafenone (70 mg bolus followed by 400–840 mg/24 h) or amiodarone (300 mg bolus followed by 600–1800 mg/24 h). The primary outcomes were the proportion of patients who had sinus rhythm 24 h after the start of the infusion, time to restoration of the first sinus rhythm and the proportion of patients with arrhythmia recurrence.
Results
Out of 209 randomized patients, 200 (96%) received the study drug. After 24 h, 77 (72.8%) and 71 (67.3%) were in sinus rhythm (
p
= 0.4), restored after a median of 3.7 h (95% CI 2.3–6.8) and 7.3 h (95% CI 5–11),
p
= 0.02, with propafenone and amiodarone, respectively. The arrhythmia recurred in 54 (52%) patients treated with propafenone and in 80 (76%) with amiodarone,
p
< 0.001. Patients with a dilated left atrium had better rhythm control with amiodarone (6.4 h (95% CI 3.5; 14.1) until cardioversion vs 18 h (95% CI 2.8; 24.7) in propafenone,
p
= 0.05).
Conclusion
Propafenone does not provide better rhythm control at 24 h yet offers faster cardioversion with fewer arrhythmia recurrences than with amiodarone, especially in patients with a non-dilated left atrium. No differences between propafenone and amiodarone on the prespecified short- and long-term outcomes were observed.</description><subject>Amiodarone</subject><subject>Amiodarone - therapeutic use</subject><subject>Anesthesiology</subject><subject>Anti-Arrhythmia Agents - therapeutic use</subject><subject>Arrhythmia</subject><subject>Atrial Fibrillation - therapy</subject><subject>Cardiac arrhythmia</subject><subject>Cardiac patients</subject><subject>Cardioversion</subject><subject>Critical Care Medicine</subject><subject>Drug delivery systems</subject><subject>Drug therapy</subject><subject>Emergency Medicine</subject><subject>Encainide hydrochloride</subject><subject>Heart</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Intensive</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original</subject><subject>Pain Medicine</subject><subject>Pediatrics</subject><subject>Pneumology/Respiratory System</subject><subject>Propafenone - therapeutic use</subject><subject>Prospective Studies</subject><subject>Rhythm</subject><subject>Sepsis</subject><subject>Septic shock</subject><subject>Shock, Septic - complications</subject><subject>Shock, Septic - drug therapy</subject><subject>Sinuses</subject><subject>Stroke Volume</subject><subject>Ventricle</subject><subject>Ventricular Function, Left</subject><issn>0342-4642</issn><issn>1432-1238</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kk1rFTEUhoMo9rb6B1xIwI2bqfmaJOOulPoBBV3oOmQyZ-5NzSRjMlPov2-ut1qUi2SRcPK8L-ccXoReUXJOCVHvCiGUi4Yw3hDFiG74E7ShgrOGMq6fog3hgjVCCnaCTku5qbiSLX2OTriSnW47sUHT15xmO0JMEfAt5LIWbCefBpv3lTFlXNY521uIS_ZuDTZjm_PubtlN3hbsIy4wL97hskvux3tscbZxSJMvMGCXqiqFUJ9VbcML9Gy0ocDLh_sMff9w9e3yU3P95ePny4vrxglNlgaEdC3rhes7okBCL3jniIaRg-Cylb0izNZhOB8G2_a8dZTybhw4UK60HPgZenvwnXP6uUJZTO3HQQg2QlqLYVoK2spOiYq--Qe9SWuOtbtK6ZZrphl5pLY2gPFxTEu2bm9qLpSiTOnaQaWaI9QWImQb6jpHX8t_8edH-HoGmLw7KmAHgcuplAyjmbOfbL4zlJh9JswhE6ZmwvzKhNmLXj9MuPYTDH8kv0NQAX4ASv2KW8iPK_iP7T1x1MDq</recordid><startdate>20231101</startdate><enddate>20231101</enddate><creator>Balik, Martin</creator><creator>Maly, Michal</creator><creator>Brozek, Tomas</creator><creator>Rulisek, Jan</creator><creator>Porizka, Michal</creator><creator>Sachl, Robert</creator><creator>Otahal, Michal</creator><creator>Brestovansky, Petr</creator><creator>Svobodova, Eva</creator><creator>Flaksa, Marek</creator><creator>Stach, Zdenek</creator><creator>Horejsek, Jan</creator><creator>Volny, Lukas</creator><creator>Jurisinova, Ivana</creator><creator>Novotny, Adam</creator><creator>Trachta, Pavel</creator><creator>Kunstyr, Jan</creator><creator>Kopecky, Petr</creator><creator>Tencer, Tomas</creator><creator>Pazout, Jaroslav</creator><creator>Belohlavek, Jan</creator><creator>Duska, Frantisek</creator><creator>Krajcova, Adela</creator><creator>Waldauf, Petr</creator><general>Springer Berlin Heidelberg</general><general>Springer</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1864-2143</orcidid></search><sort><creationdate>20231101</creationdate><title>Propafenone versus amiodarone for supraventricular arrhythmias in septic shock: a randomised controlled trial</title><author>Balik, Martin ; Maly, Michal ; Brozek, Tomas ; Rulisek, Jan ; Porizka, Michal ; Sachl, Robert ; Otahal, Michal ; Brestovansky, Petr ; Svobodova, Eva ; Flaksa, Marek ; Stach, Zdenek ; Horejsek, Jan ; Volny, Lukas ; Jurisinova, Ivana ; Novotny, Adam ; Trachta, Pavel ; Kunstyr, Jan ; Kopecky, Petr ; Tencer, Tomas ; Pazout, Jaroslav ; Belohlavek, Jan ; Duska, Frantisek ; Krajcova, Adela ; Waldauf, Petr</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c480t-e46c52b4cb907e6eb439c08ef3e43656b702a01733dda5b35c1139fd3e13786d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Amiodarone</topic><topic>Amiodarone - therapeutic use</topic><topic>Anesthesiology</topic><topic>Anti-Arrhythmia Agents - therapeutic use</topic><topic>Arrhythmia</topic><topic>Atrial Fibrillation - therapy</topic><topic>Cardiac arrhythmia</topic><topic>Cardiac patients</topic><topic>Cardioversion</topic><topic>Critical Care Medicine</topic><topic>Drug delivery systems</topic><topic>Drug therapy</topic><topic>Emergency Medicine</topic><topic>Encainide hydrochloride</topic><topic>Heart</topic><topic>Hemodynamics</topic><topic>Humans</topic><topic>Intensive</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original</topic><topic>Pain Medicine</topic><topic>Pediatrics</topic><topic>Pneumology/Respiratory System</topic><topic>Propafenone - therapeutic use</topic><topic>Prospective Studies</topic><topic>Rhythm</topic><topic>Sepsis</topic><topic>Septic shock</topic><topic>Shock, Septic - complications</topic><topic>Shock, Septic - drug therapy</topic><topic>Sinuses</topic><topic>Stroke Volume</topic><topic>Ventricle</topic><topic>Ventricular Function, Left</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Balik, Martin</creatorcontrib><creatorcontrib>Maly, Michal</creatorcontrib><creatorcontrib>Brozek, Tomas</creatorcontrib><creatorcontrib>Rulisek, Jan</creatorcontrib><creatorcontrib>Porizka, Michal</creatorcontrib><creatorcontrib>Sachl, Robert</creatorcontrib><creatorcontrib>Otahal, Michal</creatorcontrib><creatorcontrib>Brestovansky, Petr</creatorcontrib><creatorcontrib>Svobodova, Eva</creatorcontrib><creatorcontrib>Flaksa, Marek</creatorcontrib><creatorcontrib>Stach, Zdenek</creatorcontrib><creatorcontrib>Horejsek, Jan</creatorcontrib><creatorcontrib>Volny, Lukas</creatorcontrib><creatorcontrib>Jurisinova, Ivana</creatorcontrib><creatorcontrib>Novotny, Adam</creatorcontrib><creatorcontrib>Trachta, Pavel</creatorcontrib><creatorcontrib>Kunstyr, Jan</creatorcontrib><creatorcontrib>Kopecky, Petr</creatorcontrib><creatorcontrib>Tencer, Tomas</creatorcontrib><creatorcontrib>Pazout, Jaroslav</creatorcontrib><creatorcontrib>Belohlavek, Jan</creatorcontrib><creatorcontrib>Duska, Frantisek</creatorcontrib><creatorcontrib>Krajcova, Adela</creatorcontrib><creatorcontrib>Waldauf, Petr</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Intensive care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Balik, Martin</au><au>Maly, Michal</au><au>Brozek, Tomas</au><au>Rulisek, Jan</au><au>Porizka, Michal</au><au>Sachl, Robert</au><au>Otahal, Michal</au><au>Brestovansky, Petr</au><au>Svobodova, Eva</au><au>Flaksa, Marek</au><au>Stach, Zdenek</au><au>Horejsek, Jan</au><au>Volny, Lukas</au><au>Jurisinova, Ivana</au><au>Novotny, Adam</au><au>Trachta, Pavel</au><au>Kunstyr, Jan</au><au>Kopecky, Petr</au><au>Tencer, Tomas</au><au>Pazout, Jaroslav</au><au>Belohlavek, Jan</au><au>Duska, Frantisek</au><au>Krajcova, Adela</au><au>Waldauf, Petr</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Propafenone versus amiodarone for supraventricular arrhythmias in septic shock: a randomised controlled trial</atitle><jtitle>Intensive care medicine</jtitle><stitle>Intensive Care Med</stitle><addtitle>Intensive Care Med</addtitle><date>2023-11-01</date><risdate>2023</risdate><volume>49</volume><issue>11</issue><spage>1283</spage><epage>1292</epage><pages>1283-1292</pages><issn>0342-4642</issn><eissn>1432-1238</eissn><abstract>Purpose
Acute onset supraventricular arrhythmias can contribute to haemodynamic compromise in septic shock. Both amiodarone and propafenone are available interventions, but their clinical effects have not yet been directly compared.
Methods
In this two-centre, prospective controlled parallel group double blind trial we recruited 209 septic shock patients with new-onset arrhythmia and a left ventricular ejection fraction above 35%. The patients were randomised in a 1:1 ratio to receive either intravenous propafenone (70 mg bolus followed by 400–840 mg/24 h) or amiodarone (300 mg bolus followed by 600–1800 mg/24 h). The primary outcomes were the proportion of patients who had sinus rhythm 24 h after the start of the infusion, time to restoration of the first sinus rhythm and the proportion of patients with arrhythmia recurrence.
Results
Out of 209 randomized patients, 200 (96%) received the study drug. After 24 h, 77 (72.8%) and 71 (67.3%) were in sinus rhythm (
p
= 0.4), restored after a median of 3.7 h (95% CI 2.3–6.8) and 7.3 h (95% CI 5–11),
p
= 0.02, with propafenone and amiodarone, respectively. The arrhythmia recurred in 54 (52%) patients treated with propafenone and in 80 (76%) with amiodarone,
p
< 0.001. Patients with a dilated left atrium had better rhythm control with amiodarone (6.4 h (95% CI 3.5; 14.1) until cardioversion vs 18 h (95% CI 2.8; 24.7) in propafenone,
p
= 0.05).
Conclusion
Propafenone does not provide better rhythm control at 24 h yet offers faster cardioversion with fewer arrhythmia recurrences than with amiodarone, especially in patients with a non-dilated left atrium. No differences between propafenone and amiodarone on the prespecified short- and long-term outcomes were observed.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>37698594</pmid><doi>10.1007/s00134-023-07208-3</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-1864-2143</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0342-4642 |
| ispartof | Intensive care medicine, 2023-11, Vol.49 (11), p.1283-1292 |
| issn | 0342-4642 1432-1238 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2864156974 |
| source | MEDLINE; SpringerLink Journals |
| subjects | Amiodarone Amiodarone - therapeutic use Anesthesiology Anti-Arrhythmia Agents - therapeutic use Arrhythmia Atrial Fibrillation - therapy Cardiac arrhythmia Cardiac patients Cardioversion Critical Care Medicine Drug delivery systems Drug therapy Emergency Medicine Encainide hydrochloride Heart Hemodynamics Humans Intensive Medicine Medicine & Public Health Original Pain Medicine Pediatrics Pneumology/Respiratory System Propafenone - therapeutic use Prospective Studies Rhythm Sepsis Septic shock Shock, Septic - complications Shock, Septic - drug therapy Sinuses Stroke Volume Ventricle Ventricular Function, Left |
| title | Propafenone versus amiodarone for supraventricular arrhythmias in septic shock: a randomised controlled trial |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-05T12%3A43%3A20IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_proqu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Propafenone%20versus%20amiodarone%20for%20supraventricular%20arrhythmias%20in%20septic%20shock:%20a%20randomised%20controlled%20trial&rft.jtitle=Intensive%20care%20medicine&rft.au=Balik,%20Martin&rft.date=2023-11-01&rft.volume=49&rft.issue=11&rft.spage=1283&rft.epage=1292&rft.pages=1283-1292&rft.issn=0342-4642&rft.eissn=1432-1238&rft_id=info:doi/10.1007/s00134-023-07208-3&rft_dat=%3Cgale_proqu%3EA771278113%3C/gale_proqu%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2885382820&rft_id=info:pmid/37698594&rft_galeid=A771278113&rfr_iscdi=true |