Cardioversion and stroke volume index rather than heart rate alone define haemodynamic success of rate control in septic shock-associated atrial fibrillation

Q: What is the clinical evidence from this study?

Study design: Letter. Population: Septic shock-associated new-onset atrial fibrillation. Intervention: Short-acting beta-blockers (landiolol) and cardioversion vs. Rate control alone or amiodarone.

Martin Balík; Michel Slama; Bruno Lévy; Michael Fries; Michael Joannidis; Demosthenes A. Makris; Sebastian Willy Rehberg; Fabio Guarracino

doi:10.1186/s13054-026-06457-0

November 11, 2026Critical CareOpen Access

Cardioversion and stroke volume index rather than heart rate alone define haemodynamic success of rate control in septic shock-associated atrial fibrillation

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Key result

Cardioversion during beta-blocker therapy in septic shock AF improves stroke volume and cuts vasopressor needs.

Key Points

To examine whether cardioversion, stroke volume, and restored pulsatility better define hemodynamic success than heart rate reduction alone during rate control in septic shock-associated atrial fibrillation.
Correspondence analyzing hemodynamic responses and trial data from 187 patients with septic shock and supraventricular arrhythmias (76% atrial fibrillation) (NCT03029169).
Patients had left ventricular ejection fraction above 35% and received noradrenaline under 1.0 µg/kg/min, with 57% receiving concomitant arginine-vasopressin.
Comprehensive echocardiographic and hemodynamic assessments were evaluated pre-cardioversion, at 1 hour, and at 4 hours post-cardioversion.
Cardioversion in septic shock led to a significant decrease in heart rate accompanied by a significant drop in cardiac output that was not compensated by an increase in stroke volume.
For the same mean arterial pressure, the required dosage of vasopressors was significantly reduced after cardioversion.
In patients with a non-dilated left atrium, maintaining sinus rhythm under propafenone was associated with an odds ratio of 0.6 for 1-year mortality compared to amiodarone.

PICO

P

Population

Septic shock-associated new-onset atrial fibrillation

I

Intervention / Comparator

Short-acting beta-blockers (landiolol) and cardioversion vs Rate control alone or amiodarone

Limitations

Letter to the editor discussing previously published studies rather than reporting new primary clinical trial data
Evidence guiding the choice between rate versus rhythm control in critically ill patients with new-onset atrial fibrillation remains limited

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Implication

May support considering cardioversion in beta-blocked septic AF; leaves open confirmation of hemodynamic benefits in prospective trials.

Abstract

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Discussion

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Cite This Study

Balík et al. (2026) conducted a letter in Septic shock-associated new-onset atrial fibrillation. Short-acting beta-blockers (landiolol) and cardioversion vs. Rate control alone or amiodarone was evaluated. Cardioversion to sinus rhythm during beta-blocker therapy in septic shock-associated atrial fibrillation improves stroke volume index and reduces vasopressor needs despite lower cardiac output.

synapsesocial.com/papers/6af5ce22a40bbe8669e89cf7 https://doi.org/10.1186/s13054-026-06457-0

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Cardioversion and stroke volume index rather than heart rate alone define haemodynamic success of rate control in septic shock-associated atrial fibrillation

Key Points

PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Cardioversion and stroke volume index rather than heart rate alone define haemodynamic success of rate control in septic shock-associated atrial fibrillation

Key Points

PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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