Abstract
Postoperative atrial fibrillation (POAF) is one of the most frequent complications after cardiothoracic surgery and a predictor for postoperative mortality and prolonged ICU-stay. Current guidelines suggest the multi-channel inhibitor Vernakalant as a treatment option for rhythm control. However, rare cases of severe hypotension and cardiogenic shock following drug administration have been reported. To elucidate the impact of Vernakalant on hemodynamics, we included ten ICU patients developing POAF after elective cardiac surgery, all of them awake and breathing spontaneously, in this prospective trial. Patients received the recommended dosage of Vernakalant and were clinically observed and monitored (heart rate, invasive blood pressure, pulse oximetry, central venous pressure) in 1-minute-intervals for 20 minutes before- and 120 minutes after the first dose of Vernakalant. The median time from the end of surgery until occurrence of POAF amounted up to 52.8 [45.9–77.4] hours, it took 3.5 [1.2–10.1] hours from occurrence of POAF until the first application of Vernakalant. All patients received catecholamine support with epinephrine that was held steady and not dynamic throughout the observational phase. We noted stable hemodynamic conditions, with a trend towards a reduction in heart rate throughout the 120 minutes after drug administration. In 7 patients (70%), conversion to sustained sinus rhythm (SR) occurred within 8.0 minutes [6.0–9.0]. No serious adverse events (SAEs) were noted during the observation period. In this prospective trial in ICU-patients showing POAF after cardiac surgery, intravenous Vernakalant did not induce clinically relevant negative effects on patients’ hemodynamics but resulted in conversion to sustained SR after a median of 8.0 minutes in 7 out of ten patients.
Highlights
Postoperative atrial fibrillation (POAF) typically occurs around the second postoperative day and shows an especially high incidence of 40–60% in individuals undergoing cardio-surgical procedures
Even though patients with HFmrEF and HFpEF were included, none suffered from heart failure class NYHA III or IV
Catecholamine support was received by all included patients, but not changed throughout the observational phase before and after the administration of Vernakalant
Summary
Postoperative atrial fibrillation (POAF) typically occurs around the second postoperative day and shows an especially high incidence of 40–60% in individuals undergoing cardio-surgical procedures. It represents a strong contributor for major cardiac adverse events in the short and the long run[1]. POAF leads to complications such as ventricular arrythmias, congestive heart failure, the need for permanent pacemaker implantation, prolonged mechanical ventilation and ICU-stay, an increased risk for infection[1,2], and is even associated with increased overall and cardiovascular mortality[3]. We aimed at providing a stepping-stone for further research in large patient collectives
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