Introduction with a case
Why did she develop hypotension?
Predicting the hemodynamic effect of cardioversion
Target heart rate for atrial fibrillation patient in septic shock?
Final thoughts on the case
- Hemodynamic improvement after cardioversion is more likely when the initial heart rate is very fast. Patients with a heart rate under 150 b/m are less likely to improve immediately following cardioversion.
- Patients treated with negative chronotrophic agents prior to cardioversion may be pushed in a slow sinus rhythm without the ability to mount a compensatory sinus tachycardia. For patients with severe systolic dysfunction, this can precipitate cardiogenic shock.
- For patients with chronic AF in septic shock, attempting to “normalize” the heart rate will reduce the cardiac output. Such patients may benefit from permissive tachycardia.