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Potassium infusion increases the likelihood of conversion of recent-onset atrial fibrillation—A single-blinded, randomized clinical trial

The American heart journal, 2020-03, Vol.221, p.114-124 [Peer Reviewed Journal]

2020 Elsevier Inc. ;Copyright © 2020 Elsevier Inc. All rights reserved. ;2020. Elsevier Inc. ;info:eu-repo/semantics/openAccess ;ISSN: 0002-8703 ;EISSN: 1097-6744 ;DOI: 10.1016/j.ahj.2019.12.014 ;PMID: 31986288

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Title:
Potassium infusion increases the likelihood of conversion of recent-onset atrial fibrillation—A single-blinded, randomized clinical trial
Author: Tazmini, Kiarash ; Fraz, Mai S. Aa ; Nymo, Ståle H. ; Stokke, Mathis K. ; Louch, William E. ; Øie, Erik
Subjects: Aged ; Atrial Fibrillation - blood ; Atrial Fibrillation - drug therapy ; Atrial Flutter - blood ; Atrial Flutter - drug therapy ; Cardiac arrhythmia ; Cardiovascular disease ; Clinical trials ; Community health care ; Control methods ; Conversion ; Drugs ; Electrocardiography ; Family physicians ; Female ; Fibrillation ; Flutter ; Heart failure ; Hospitals ; Humans ; Infusions, Intravenous ; Injection Site Reaction ; Levels ; Male ; Median (statistics) ; Middle Aged ; Pain ; Patients ; Potassium ; Potassium - blood ; Potassium chloride ; Potassium Chloride - therapeutic use ; Proportional Hazards Models ; Pulmonary arteries ; Single-Blind Method ; Statistical analysis ; Time Factors ; Treatment Outcome ; Vibration
Is Part Of: The American heart journal, 2020-03, Vol.221, p.114-124
Description: The optimal antiarrhythmic management of recent-onset atrial fibrillation (ROAF) or atrial flutter is controversial and there is a considerable variability in clinical treatment strategies. It is not known if potassium infusion has the potential to convert ROAF or atrial flutter to sinus rhythm (SR). Therefore, we aimed to investigate if patients with ROAF or atrial flutter and plasma-potassium levels ≤4.0 mmol/L have increased probability to convert to SR if the plasma-potassium level is increased towards the upper reference range (4.1-5.0 mmol/L). In a placebo-controlled, single-blinded trial, patients with ROAF or atrial flutter and plasma-potassium ≤4.0 mmol/L presenting between April 2013 and November 2017 were randomized to receive potassium chloride (KCl) infusion (n = 60) or placebo (n = 53). Patients in the KCl group received infusions at one of three different rates: 9.4 mmol/h (n = 11), 12 mmol/h (n = 19), or 15 mmol/h (n = 30). There was no statistical difference in the number of conversions to SR between the KCl group and placebo [logrank test, P = .29; hazard ratio (HR) 1.20 (CI 0.72-1.98)]. However, KCl-infused patients who achieved an above-median hourly increase in plasma-potassium (>0.047 mmol/h) exhibited a significantly higher conversion rate compared with placebo [logrank P = .002; HR 2.40 (CI 1.36-4.21)] and KCl patients with below-median change in plasma-potassium [logrank P < .001; HR 4.41 (CI 2.07-9.40)]. Due to pain at the infusion site, the infusion was prematurely terminated in 10 patients (17%). Although increasing plasma-potassium levels did not significantly augment conversion of ROAF or atrial flutter to SR in patients with potassium levels in the lower-normal range, our results indicate that this treatment may be effective when a rapid increase in potassium concentration is tolerated and achieved.
Publisher: United States: Elsevier Inc
Language: English;Norwegian
Identifier: ISSN: 0002-8703
EISSN: 1097-6744
DOI: 10.1016/j.ahj.2019.12.014
PMID: 31986288
Source: MEDLINE
NORA Norwegian Open Research Archives
ProQuest Central

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Potassium infusion increases the likelihood of conversion of recent-onset atrial fibrillation—A single-blinded, randomized clinical trial

2020 Elsevier Inc. ;Copyright © 2020 Elsevier Inc. All rights reserved. ;2020. Elsevier Inc. ;info:eu-repo/semantics/openAccess ;ISSN: 0002-8703 ;EISSN: 1097-6744 ;DOI: 10.1016/j.ahj.2019.12.014 ;PMID: 31986288

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