Control Versus Liberal Cardiac Frequency in Patients in Sepse With Atrial Fibrillation of High Ventricular Response

University of Sao Paulo General Hospital126 enrolled

Overview

Amiodarone is considered the medicine of choice in heart rate control in critically ill patients with atrial fibrillation with high ventricular response. However, a recent retrospective study showed a greater number of events in critical patients in whom there was an attempt to control versus in which there was no. Therefore, the prospective and randomized comparative use of amiodarone in this group of patients has not yet been described. The aim of this study was to evaluate the safety of the use of amiodarone (restricted group) versus placebo (liberal group) in heart rate control in atrial fibrillation with high ventricular response in patients with sepsis and vasopressor cardiovascular dysfunction. For this, a unicentric, randomized, blind and prospective study will be performed, in which the restrictive versus liberal strategy is performed in a comparative way. Hospital data (test results, medical evolutions complications) of patients will be analyzed to calculate safety and effectiveness. Expected results: The liberal strategy is superior to the restrictive strategy and causes fewer adverse events.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

126

Conditions

Sepsis Septic Shock Atrial Fibrillation

Interventions

AmiodaroneDRUG

Administration of the drug will be blinded within the first 48 hours for the principal investigator. Amiodarone (5 mg / kg EV in 30 minutes) will be the drug of choice in the Restricted group blinded to the principal investigator. If there is no reversal / control and there is no adverse event, a further dose of the same previously administered medicinal product will be performed within 30 minutes, amiodarone 3 mg / kg. After the second dose, continuous infusion of amiodarone at a dose of 900 mg in 24 hours will be initiated.

0.9% physiological solutionDRUG

Administration of 0.9% physiological solution.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Permanent FA presence with FC\> 110 bpm * Presence of infection (any infectious outbreak) * Cardiovascular dysfunction - need for vasopressor drugs (noradrenaline, adrenaline or vasopressin) to maintain SBP\> 90 mmHg * Signed consent form Exclusion Criteria: * Pregnancy * Body mass index greater than 40 kg / m2 * Contraindication to the use of oral or parenteral anticoagulants * Acute coronary syndrome * Left ventricular ejection fraction \<35% * Valvular Heart Disease * Contraindication to the use of amiodarone * Child C cirrhosis * Dialytic chronic renal insufficiency * Chronic obstructive pulmonary disease * Acute myocarditis * Pulmonary thromboembolism * Terminal neoplasia

Outcomes

Primary Outcomes

Complications of safety outcomes

Need for orotracheal intubation, Bradycardia requiring specific treatment or transvenous pacemaker, Confirmed embolic event, Need for association of another vasoactive drug or dose increase of already used vasoactive drug\> 50% of initial, Cardiorespiratory arrest, Death

Time frame: 48 hours

Secondary Outcomes

Effectiveness in the control of the heart rate

Comparison between the effectiveness in the control of the heart rate of AF among patients of the Restricted versus Liberal group. Effective control will be considered when the patient reaches heart rate \<100 bpm