Vasopressin in Septic Shock Lowers Risk of Atrial Fibrillation (and Maybe Death) | JAMA

Atrial fibrillation is commonly observed in patients experiencing distributive-type shock and is associated with increased mortality and hospital length-of-stay.  Co-administration of vasopressin along with catecholaminergic vasopressors (compared with catecholamines alone) resulted in 68/1000 fewer cases of atrial fibrillation in the context of distributive shock.

Distributive shock is characterized by systemic vasodilation and hypotension, and is most commonly caused by sepsis, although anaphylaxis, spinal cord injury, and cardiovascular surgery may also give rise to this condition.  Standard of care for distributive shock is currently intravenous administration of catecholaminergic vasopressors, most commonly norepinephrine, dopamine, epinephrine or dobutamine.

Adrenergic hyperactivation, particularly as it relates to the cardiac beta adrenergic response, resulting from large doses of catecholamines can be arrythmogenic and cause excessive myocardial oxygen demand.  By lowering the catecholamine vasopressor dose requirement, vasopressin may lower pharmacological arrythmogenicity and decrease the incidence of atrial fibrillation during distributive shock.

While the primary endpoint, the occurrence of atrial fibrillation, showed a statistically significant reduction when vasopressin was co-administered with catecholaminergic vasopressors vs. catecholamines alone, the results were less clear concerning other outcomes.  In the pooled data, patient mortality decreased when vasopressin was co-administered with catecholaminergic vasopressors, but sub-analysis of only the least potentially-biased studies demonstrated only a non-statistically significant effect.



Source: Association of Vasopressin Plus Catecholamine Vasopressors vs Catecholamines Alone With Atrial Fibrillation in Patients With Distributive Shock: A Systematic Review and Meta-analysis | Atrial Fibrillation | JAMA | JAMA Network