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Adding vasopressin to catecholamines may lower AF risk in distributive shock
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The addition of vasopressin to catecholamine vasopressors compared with catecholamines alone was associated with a lower atrial fibrillation risk in patients with distributive shock, according to a systematic review and meta-analysis published in JAMA.
William F. McIntyre, MD, from McMaster University in Hamilton, Ontario, Canada, and colleagues analyzed whether treatment for distributive shock with vasopressin plus catecholamine vasopressors compared with catecholamine vasopressors alone was associated with reduction in risk for adverse events in 23 randomized clinical trials covering 3,088 patients (mean age, 61 years; 45% women).
According to the study background, AF is a common adverse event associated with catecholamine use.
The primary outcome was AF. Other outcomes of interest included mortality and requirement for renal replacement therapy.
Vasopressin treatment was associated with a lower AF risk (RR = 0.77; 95% CI, 0.67-0.88; risk difference [RD] = 0.06, 95% CI, 0.13 to 0.01).
The overall RR estimate associated with vasopressin plus catecholamine vasopressors for mortality was 0.89 (95% CI, 0.82-0.97; RD = 0.04; 95% CI, 0.07 to 0); however, the RR estimate was not significant (RR = 0.96; 95% CI, 0.84-1.11) when limited to trials at low risk for bias.
The overall RR estimate for renal replacement therapy was 0.74 (95% CI, 0.51-1.08; RD = 0.07; 95% CI, 0.12 to 0.01). However, RR was 0.7 (95% CI, 0.53-0.92; P for interaction = .77) in an analysis limited to trials at low risk for bias, and there were no significant differences in the pooled risks for other outcomes.
“To our knowledge, this systematic review is the first on the topic to include atrial fibrillation as an outcome. Prior reviews assessed arrhythmia, but this outcome has limited utility due to the variety of conditions that could be found under this heading,” the researchers wrote. “Addition of vasopressin to catecholamines may offer a clinical advantage for prevention of atrial fibrillation.” − by Dave Quaile
Disclosures: McIntyre reports receiving grant funding from the Canadian Stroke Prevention Intervention Network and being a trainee member of the Cardiac Arrhythmia Network of Canada. Please see the study for all other authors’ relevant financial disclosures.
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