Effectiveness of heart rate control on hemodynamics in critically ill patients with atrial tachyarrhythmias managed by amiodarone

Joe-Elie Salem (1, 1, 2) , Pauline Dureau (1, 2) , Christian Funck-Brentano (1, 2) , Jean-Sébastien Hulot (1, 2) , Maria Aissaoui (3) , Nadia Aissaoui (3) , Saik Urien (4) , Christophe Faisy (1, 2, 4)

1 CHU Pitié-Salpêtrière [AP-HP]
2 ICAN - Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
3 HEGP - Hôpital Européen Georges Pompidou [APHP]
4 CIC 1419 - CIC - Mère Enfant Necker Cochin Paris Centre

Atrial tachyarrhythmias (AT) are common in intensive care unit (ICU) patients and might contribute to hemodynamic instability if heart rate (HR) is persistently too rapid. We aimed to assess if HR control below 115 or 130 bpm with amiodarone improves hemodynamics in ICU patients with AT. This observational study included 73 ICU patients with disabling AT receiving amiodarone for HR control. A total of 525 changes (mainly within 4–8 h) in mean arterial pressure (MAP) and 167 changes in plasma lactate in response to HR variations above 115 or 130 bpm were analyzed. Epinephrine, sedative drugs, fluid loading, use of diuretics, continuous renal replacement therapy and amiodarone dosing were among covariables assessed. Univariable analysis showed that HR variations above 115 bpm were poorly correlated to change in MAP (r = 0.11, p < 0.01). Multivariable analysis showed that changes in MAP were still positively associated to HR variation (p < 0.05) and to initiation or termination of epinephrine (p < 0.05) or sedatives infusions (p < 0.05). Changes in plasma lactate did not correlate to HR variations above 115 bpm. When considering 130 bpm as a threshold, HR variations were not associated to changes in MAP or to changes in plasma lactate. Amiodarone dose was associated to HR decrease but not to MAP or plasma lactate increase.

Mots clés: Amiodarone; Atrial tachyarrhythmia; Pharmacology; Shock; Heart rate

Domaines: Cardiologie et système cardiovasculaire; Médicaments

Joe-Elie Salem, Pauline Dureau, Christian Funck-Brentano, Jean-Sébastien Hulot, Maria Aissaoui, et al.. Effectiveness of heart rate control on hemodynamics in critically ill patients with atrial tachyarrhythmias managed by amiodarone. Pharmacological Research, 2017, 122, pp.118 - 126. ⟨10.1016/j.phrs.2017.06.004⟩. ⟨hal-01540356⟩