普罗帕酮
医学
胺碘酮
心脏病学
内科学
感染性休克
射血分数
心房颤动
丸(消化)
抗心律失常药
麻醉
心力衰竭
心脏病
败血症
作者
Petr Waldauf,Michal Pořízka,Jan Horejsek,Michal Otáhal,Eliška Svobodová,Ivana Jurisinova,Morgan Maly,Tomáš Brožek,Jan Rulíšek,Pavel Trachta,Tomáš Tencer,Adéla Krajčová,František Duška,Martin Borggrefe
出处
期刊:European heart journal. Acute cardiovascular care
[Oxford University Press]
日期:2024-02-19
标识
DOI:10.1093/ehjacc/zuae023
摘要
A recently published trial has shown no differences in outcomes between patients with new-onset supraventricular arrhythmia (SVA) in septic shock treated with either propafenone or amiodarone. However, these outcome data have not been evaluated in relation to the presence or absence of a dilated left atrium (LA).Patients with SVA and a left ventricular ejection fraction ≥35% were randomized to receive intravenous propafenone (70mg bolus followed by 400-840mg/24h) or amiodarone (300mg bolus followed by 600-1800mg/24h). They were divided into groups based on whether their end-systolic left atrial volume (LAVI) was ≥40 ml/m². The subgroup outcomes assessed were survival at ICU discharge, 1-month, 3-months, 6-months, and 12-months.Propafenone cardioverted earlier (p=0.009) and with fewer recurrences (p=0.001) in the patients without LA enlargement (n=133). Patients with LAVI˂40ml/m2 demonstrated a mortality benefit of propafenone over the follow up of 1-year (Cox regression, HR 0.6 (95% CI 0.4; 0.9), p=0.014). Patients with dilated LA (n=37) achieved rhythm control earlier in amiodarone (p=0.05) with similar rates of recurrences (p=0.5) compared to propafenone. The outcomes for patients with LAVI≥40 ml/m2 were less favourable with propafenone compared to amiodarone at 1-month (HR 3.6 (95% CI 1.03; 12.5), p=0.045) however, it did not reach statistical significance at 1 year (HR 1.9 (95% CI 0.8; 4.4), p=0.138).Patients with non-dilated LA who achieved rhythm control with propafenone in the setting of septic shock had better short-term and long-term outcomes than those treated with amiodarone, which seemed to be more effective in patients with LAVI≥40 ml/m².ClinicalTrials.gov Identifier: NCT03029169, registered on 24th of January 2017.
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