Echocardiography predictors of sustained sinus rhythm after cardioversion of supraventricular arrhythmia in patients with septic shock

• Published in: Journal of critical care Vol. 83; p. 154832
• Main Authors: Balik, M., Waldauf, P., Maly, M., Brozek, T., Rulisek, J., Porizka, M., Sachl, R., Otahal, M., Brestovansky, P., Svobodova, E., Flaksa, M., Stach, Z., Horejsek, J., Volny, L., Jurisinova, I., Novotny, A., Trachta, P., Kunstyr, J., Kopecky, P., Tencer, T., Pazout, J., Krajcova, A., Duska, F.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2024; Elsevier Limited
• Subjects: A wave velocity-time-integral; Antiarrhythmics; Atrial fibrillation; Cardiac arrhythmia; Cardioversion; Clinical trials; Doppler effect; Ejection fraction; Ethics; Heart rate; Hemodynamics; Left atrial emptying fraction; Left atrial end-systolic volume; Left-atrial end-systolic diameter; Medical prognosis; Patients; Pulmonary hypertension; Sepsis; Sinuses; Trans-mitral a wave; Ultrasonic imaging; CRP; PCT; RV; TTE; A wave velocity-time-integral; EF_LV; LV; VTI; K; LVOT; Left atrial end-systolic volume; WBC; Hb; SR; EF; SV; Left atrial emptying fraction; AF; DCC; Atrial fibrillation; LA_EF; Trans-mitral a wave; LAVi; TAPSE; APACHE II; SOFA; PAPs; AV; LA; Mg2; Left-atrial end-systolic diameter; ICU
• ISSN: 0883-9441; 1557-8615; 1557-8615
• DOI: 10.1016/j.jcrc.2024.154832

The echocardiography parameters may predict the maintenance of sinus rhythm after cardioversion of a supraventricular arrhythmia (SVA). Patients in septic shock with onset of an SVA, normal to moderately reduced LV systolic function (EF_LV˃̳35%) and on a continuous noradrenaline of <1.0 μg/kg.min were included. Echocardiography was performed at the arrhythmia onset, 1 h and 4 h post cardioversion on an infusion of propafenone or amiodarone. Cardioversion was achieved in 96% of the 209 patients within a median time of 6(1.8–15.6)h, 134(64.1%) patients experienced at least one SVA recurrence after cardioversion. At 4 h the left atrial emptying fraction (LA_EF, cut-off 38.4%, AUC 0.69,p˂0.001), and transmitral A wave velocity-time-integral (Avti, cut-off 6.8 cm, AUC 0.65,p = 0.001) showed as limited predictors of a single arrhythmia recurrence. The LA_EF 44(36,49)%, (p = 0.005) and the Avti 8.65(7.13,9.50)cm, (p < 0.001) were associated with sustained sinus rhythm and decreased proportionally to increasing numbers of arrhythmia recurrences (p < 0.001 and p = 0.007, respectively). The enlarged left atrial end-systolic diameter at the arrhythmia onset (p = 0.04) and elevated systolic pulmonary artery pressure at 4 h (p = 0.007) were weak predictors of multiple(˃3) recurrences. The LA_EF and Avti are related to arrhythmia recurrences post-cardioversion suggesting potential guidance to the choice between rhythm and rate control strategies. Trial registration: ClinicalTrials.gov Identifier: NCT03029169, registered on 24th of January 2017. •Echocardiography can guide arrhythmia management in septic shock.•Echocardiography may monitor atrial functional recovery after cardioversion.•LA functional 2D and Doppler parameters are related to arrhythmia recurrences.•LA_EF > 44% and Avti>8.7 cm post cardioversion predicted maintenance of sinus rhythm.•Echocardiography could help to decide between rhythm and rate control strategy.