• Martin Balik, Michal Maly, Tomas Brozek, Jan Rulisek, Michal Porizka, Robert Sachl, Michal Otahal, Petr Brestovansky, Eva Svobodova, Marek Flaksa, Zdenek Stach, Jan Horejsek, Lukas Volny, Ivana Jurisinova, Adam Novotny, Pavel Trachta, Jan Kunstyr, Petr Kopecky, Tomas Tencer, Jaroslav Pazout, Jan Belohlavek, Frantisek Duska, Adela Krajcova, and Petr Waldauf.
• Department of Anesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00, Prague 2, Czech Republic. martin.balik@vfn.cz.
• Intensive Care Med. 2023 Nov 1; 49 (11): 128312921283-1292.

PurposeAcute onset supraventricular arrhythmias can contribute to haemodynamic compromise in septic shock. Both amiodarone and propafenone are available interventions, but their clinical effects have not yet been directly compared.MethodsIn this two-centre, prospective controlled parallel group double blind trial we recruited 209 septic shock patients with new-onset arrhythmia and a left ventricular ejection fraction above 35%. The patients were randomised in a 1:1 ratio to receive either intravenous propafenone (70 mg bolus followed by 400-840 mg/24 h) or amiodarone (300 mg bolus followed by 600-1800 mg/24 h). The primary outcomes were the proportion of patients who had sinus rhythm 24 h after the start of the infusion, time to restoration of the first sinus rhythm and the proportion of patients with arrhythmia recurrence.ResultsOut of 209 randomized patients, 200 (96%) received the study drug. After 24 h, 77 (72.8%) and 71 (67.3%) were in sinus rhythm (p = 0.4), restored after a median of 3.7 h (95% CI 2.3-6.8) and 7.3 h (95% CI 5-11), p = 0.02, with propafenone and amiodarone, respectively. The arrhythmia recurred in 54 (52%) patients treated with propafenone and in 80 (76%) with amiodarone, p  < 0.001. Patients with a dilated left atrium had better rhythm control with amiodarone (6.4 h (95% CI 3.5; 14.1) until cardioversion vs 18 h (95% CI 2.8; 24.7) in propafenone, p = 0.05).ConclusionPropafenone does not provide better rhythm control at 24 h yet offers faster cardioversion with fewer arrhythmia recurrences than with amiodarone, especially in patients with a non-dilated left atrium. No differences between propafenone and amiodarone on the prespecified short- and long-term outcomes were observed.© 2023. Springer-Verlag GmbH Germany, part of Springer Nature.

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