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Hemodynamic effects of Vernakalant in cardio-surgical ICU-patients treated for recent-onset postoperative atrial fibrillation.

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.

SUBMITTER: Schnaubelt S

PROVIDER: S-EPMC7176672 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Hemodynamic effects of Vernakalant in cardio-surgical ICU-patients treated for recent-onset postoperative atrial fibrillation.

Schnaubelt S S Niederdöckl J J Simon A A Schütz N N Holaubek C C Edlinger-Stanger M M Niessner A A Steinlechner B B Sulzgruber P P Spiel A O AO Domanovits H H

Scientific reports 20200422 1

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 P ...[more]

PMID: 32321982

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Project description:IntroductionPostoperative atrial fibrillation (POAF) is a common complication following cardiac surgery associated with increased morbidity and mortality. Although sustained hyperglycemia is a known risk factor of AF and poor ICU outcomes, emerging in-vitro studies reveal acute glycemic fluctuations to be an additional independent predictor of AF. The effect of acute glycemic fluctuations on the incidence of POAF in the clinical setting remains unclear. We aim to investigate the effect of the magnitude of acute perioperative glycemic fluctuations on the incidence of POAF in a multi-ethnic Southeast-Asian population.MethodsWe obtained data from1743 patients who underwent elective CABG in a tertiary heart centre from 2009-2011. Patients were kept to a tight baseline glycemic control in accordance with hospital protocol. The magnitude of the difference between the highest and lowest perioperative glucose levels up till the first 48 postoperative hours was employed as a measure of glycemic fluctuation. Patients were divided into 4 groups for analysis based on the magnitude of glycemic fluctuation:A)0-2mmol/L(N = 147); B)>2-4mmol/L(N = 426); C)>4-6mmol/L(N = 513); D)>6mmol/L(N = 657).Our primary outcome was the incidence of POAF. Secondary outcomes included ICU and 30-day mortality and length of stay.ResultsThe overall incidence of POAF was 14.7%. This increased as the magnitude of glycemic fluctuation increased, and was statistically highest in Group D(16.4%) as compared with the other 3 sub-groups. Multivariate logistic regression revealed the magnitude of perioperative glycemic fluctuation to be an independent risk factor of POAF(O.R.1.06, 95% C.I.1.01-1.11, p = 0.014).ICU length of stay was statistically highest in Group D(63.1 hours, p = < .001). However, ICU and 30 day mortality rates were similar among the 4 groups.ConclusionIncreased magnitudes of acute perioperative glycemic fluctuations are associated with a significantly increased risk of POAF and length of ICU stay; and should therefore be minimised but balanced against the risks of hypoglycemia so as to avoid POAF and optimise patient outcomes.

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Hemodynamic effects of Vernakalant in cardio-surgical ICU-patients treated for recent-onset postoperative atrial fibrillation.

Publications

Hemodynamic effects of Vernakalant in cardio-surgical ICU-patients treated for recent-onset postoperative atrial fibrillation.

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