Elizabeth Gau, BCCCP, PharmD
Pharmacist
Sanford Medical Center Fargo, United States
Disclosure information not submitted.
Megan Moore, BCCCP, BCPS, PharmD
Critical Care Pharmacist
Sanford Medical Center Fargo, United States
Disclosure information not submitted.
Title: Effect of Vasopressor Choice on Atrial Fibrillation with Rapid Ventricular Response in Septic Shock
INTRODUCTION/HYPOTHESIS: Septic shock may result in atrial fibrillation (AF) recurrence and new onset atrial fibrillation (NOAF) due to fluid shifts, systemic inflammation, and vasopressor use. Recurrence of AF and NOAF are associated with a higher severity of illness and increased mortality. The purpose of this study was to compare septic shock patients with AF or NOAF and rapid ventricular response (RVR) managed on norepinephrine versus phenylephrine to determine if there was a difference in proportion of time in AF with RVR.
Methods: This was a single-center, retrospective cohort study in patients with septic shock who developed AF with RVR, defined by two consecutive heart rates of at least 110 beats per minute with an irregular heart rhythm. The primary outcome was proportion of time in AF with RVR among patients on norepinephrine versus those transitioned to phenylephrine. Secondary outcomes included proportion of time in AF with RVR before and after patients were transitioned to phenylephrine, proportion of time in AF with RVR at hours 6, 12, 24, and 48 after initiation of any vasopressor, intensive care unit (ICU) length of stay (LOS), hospital LOS, ICU mortality, and 28-day mortality.
Results: Of 29 included patients, 19 were treated exclusively with norepinephrine and 10 were transitioned to phenylephrine. The primary outcome of proportion of time in AF with RVR among patients who received norepinephrine therapy at any point was 0.28 (0.16-0.60) and 0.24 (0.09-0.50) in patients transitioned to phenylephrine (p=0.53). In patients transitioned to phenylephrine the proportion of time in AF with RVR was 0.56 (0.63-1) while on norepinephrine versus 0.24 (0.09-0.50) on phenylephrine (p=0.02). Proportion of time in AF with RVR at hours 6, 12, 24, and 48 after initiation of vasopressor therapy was similar in both groups. Patients transitioned to phenylephrine had a longer median ICU LOS (18 versus 8 days), hospital LOS (21 versus 12 days), and 28-day mortality (40% versus 26%), however these differences did not reach statistical significance.
Conclusion: The transition from norepinephrine to phenylephrine did not reduce proportion of time in AF with RVR, however phenylephrine may be associated with longer ICU LOS, hospital LOS, and 28-day mortality.