{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T14:10:32Z","timestamp":1778163032242,"version":"3.51.4"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009553","name":"Agentura Pro Zdravotnick\u00fd V\u00fdzkum \u010cesk\u00e9 Republiky","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009553","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003243","name":"Ministerstvo Zdravotnictv\u00ed Cesk\u00e9 Republiky","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003243","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Supraventricular arrhythmias (SVA) are common in mechanically ventilated patients with septic shock and may be aggravated by right ventricular (RV) dysfunction. Optimal rhythm-control strategies in this setting remain uncertain. We explored whether propafenone differs from amiodarone in maintaining sinus rhythm in patients with RV dysfunction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This exploratory sub-analysis of the randomized double-blind PRASE trial included patients with septic shock who developed new-onset SVA, had preserved to moderately reduced left ventricular systolic function (ejection fraction &amp;gt;35%), and received continuous norepinephrine at doses &amp;lt;1.0\u2005\u00b5g\/kg\/min. Patients were classified according to the presence or absence of RV dysfunction using comprehensive echocardiographic criteria. Outcomes included cardioversion at 24\u2005h, arrhythmia recurrence, multiple recurrences, and 12-month survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 162 patients with sufficient echocardiographic data, 73 (45%) met criteria for RV dysfunction. Of these, 42 received propafenone and 31 amiodarone; 89 patients without RV dysfunction served as controls. Cardioversion at 24\u2005h did not differ significantly between propafenone and amiodarone in patients with RV dysfunction (69% vs. 56.7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.30). However, arrhythmia recurrence occurred less frequently with propafenone (50%) compared with amiodarone (83.9%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003; OR 0.19, 95% CI 0.06\u20130.56). Multiple (&amp;gt;3) recurrences were also less common with propafenone (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.028; OR 0.24, 95% CI 0.06\u20130.84). RV dysfunction was not associated with worse 12-month survival compared with controls, and no significant survival difference between antiarrhythmic strategies was observed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In mechanically ventilated patients with septic shock and RV dysfunction, propafenone was associated with fewer arrhythmia recurrences compared with amiodarone, despite similar short-term cardioversion rates. These findings are hypothesis-generating and suggest that propafenone may represent a promising alternative to amiodarone for rhythm control in critically ill patients with right ventricular dysfunction, warranting further prospective evaluation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov Identifier: NCT03029169.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1807380","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T13:13:51Z","timestamp":1778159631000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Propafenone is associated with fewer recurrences of supraventricular arrhythmias in mechanically ventilated patients with septic shock and right ventricular dysfunction"],"prefix":"10.3389","volume":"13","author":[{"given":"M.","family":"Balik","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital in Prague","place":["Prague, Czechia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T.","family":"Tencer","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care, 2nd Faculty of Medicine, Charles University and University Hospital Motol","place":["Prague, Czechia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E.","family":"Svobodova","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University and General University Hospital in Prague","place":["Prague, 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Czechia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Krajcova","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care, 3rd Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital","place":["Prague, Czechia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F.","family":"Duska","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care, 3rd Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital","place":["Prague, Czechia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P.","family":"Waldauf","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care, 3rd Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital","place":["Prague, 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