Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Atrial Fibrillation (AF) is a common complication in patients with sepsis, and imposes a worse prognosis and challenging clinical management. Administration of antiarrhythmics is often needed, to achieve rate or rhythm control, especially in the occurrence of AF with rapid ventricular response; however, it is unclear whether different classes of antiarrhythmics are associated with better outcomes in patients with sepsis and AF.
Methods
We performed a systematic review and meta-analysis according to PRISMA Guidelines. Pubmed and EMBASE databases were systematically searched for studies reporting outcomes in patients with sepsis and AF, according to the use of Beta-blockers (BBs), calcium-channel blockers (CCBs), digoxin and amiodarone. Random-effect models were used to provide pooled estimates; fixed-effect models were also performed as a sensitivity analysis.
Results
Among 4,166 studies, 2 articles were included from the literature search, and an additional 1 from the author’s knowledge, yielding a total of 40,593 patients with sepsis and AF included. According to the data available from the included studies, the meta-analysis was performed only for in-hospital mortality. BBs were associated with a reduced risk of in-hospital mortality compared to amiodarone (OR 0.52, 95% CI: 0.46-0.58; I2 = 0%, Figure 1, Panel C), while no significant differences were observed for BBs. vs. CCBs (Figure 1, Panel A) and for BBs vs. digoxin (Figure 1, Panel B). In the pre-specified sensitivity analysis using a fixed-effect model, BBs resulted associated with a lower risk of in-hospital mortality compared with both CCBs and digoxin).
Conclusion
In patients with AF during sepsis, BBs were associated with reduced risk of in-hospital mortality, compared to amiodarone; inconclusive results emerged for the comparisons between BBs and CCBs or digoxin, although with a benefit of BBs observed in the fixed-effect models. Further studies are needed to provide definitive data and to guide physicians in the choice of the best rate control strategy in this clinical setting. Abstract Figure.
Pulmonary Vein Isolation Compared to Rate Control in Patients with Atrial Fibrillation: A Systematic Review and Meta-analysis
