Electric Cardioversion

Abstract: Angiotensin II exerts proinflammatory effects leading to atrial fibrosis that is associated with persistence of atrial fibrillation (AF). Renal function plays a major role in activation of the renin–angiotensin–aldosterone system. We examined whether the level of impaired renal function, defined by glomerular filtration rate (GFR), would influence the maintenance of sinus rhythm after successful external electric cardioversion (ECV). One hundred two consecutive patients with persistent AF underwent successful ECV. Patients were prospectively followed for recurrence of AF by telephone interviews, Holter electrocardiograms, and electrocardiograms sent by primary care providers. Repeated GFR assays were performed before and 1 month after ECV. Patients were divided into 4 groups according to baseline GFR (I >90 ml/min, II 60 to 90 ml/min, III 30 to 59 ml/min, IV

Abstract: The occurrence of supraventricular arrhythmias is associated with an unfavourable prognosis in septic shock. Available trials are difficult to apply in sepsis and septic shock patients due to included cohorts, control groups and because "one size does not fit all". The priorities in the critically ill are maintenance of the sinus rhythm and diastolic ventricular filling. The rate control modality should be reserved for chronic AF and in situations when the sinus rhythm is difficult to maintain due to extreme stress conditions resulting from a high dosage of vasoactive agents. Electric cardioversion is indicated in unstable patients with an absence of contraindications and is more feasible in combination with an antiarrhythmic agent. Besides amiodarone being preferred for its lower cardiodepressant side effect compared to other agents, drugs with a different degree of betablocking activity are very useful in supraventricular arrhythmias and septic shock, providing echocardiography is routinely used to support their indications within the current summary of product characteristics. A typical patient benefiting from propafenone is without significant structural heart disease, i.e. typically with normal to moderately reduced left ventricular systolic function. Future research should be channelled towards echocardiography-guided prospective controlled trials on antiarrhythmic therapy which may clarify the issue of rhythm versus rate control, the effects of various antiarrhythmic drugs, and a place for electric cardioversion in critically ill patients in septic shock.