Arrhythmia Atrial Clinical Trial
Official title:
Fluid Responsiveness Evaluation in Patients With Acute Circulatory Failure and Arrhythmia With Atrial Fibrillation: Indice Delta ITV / Delta RR
Fluid therapy is often used as first line treatment of acute circulatory failure, aiming an
increase in cardiac output (by improving preload) and in tissue perfusion. Depending on left
ventricular systolic function, fluid challenge could lead to an increase in cardiac ouput and
tissue perfusion, or only detrimental consequences (by fluid overload and aggravation of lung
and tissues oedema, increase of morbi-mortality). Patients are defined as responders to fluid
therapy if one can observe an increase of cardiac output up to 15% after fluid therapy (500ml
of crystalloids): gold standard test used in most of the studies on the subject. Literature
reports on heterogenous populations a reproductible and constant response rate to this fluid
challenge of 50%. It seems reasonable to dispose of indices allowing to predict fluid
responsiveness without resulting in fluid intake. Statics markers have been abandonned for
several years and dynamics methods have been developped.
In front of arrythmia, validated methods are scarce. Passive leg rising method appears to be
the only one and it's validity seems to be less well documented than in sinusal patients. The
purpose of this study is to determine a new method to assess fluid responsiveness in
arrythmic patients.
In atrial fibrillation, RR interval varies widely between cardiac cylces. Systolic interval
remain constant. Variations will occure at expense of diastolic interval, or ventricular
filling interval. One can reliably assume that when RR is longer, preload is rising. If the
patient is on the ascendant part of the Franck-Starling curve, a longer RR should cause au
greater VTI (Vitess Time Integral, surrogate of cardiac output).
The evaluation by transthoracic echocardiography of the indice delta ITV / delta RR should
determine the degree of fluid responsiveness in arrhythmic patients.
After decision of fluid expansion, patients will have haemodynamic and echocardiographic data
measured, delta ITV / delta RR indice assessed, then passive leg rising and fluid expansion
with 500 ml of cristalloids administered, with evaluation of VTI (as surrogate of cardiac
output) at each time. Fluid responders will be compared to non-responders to evaluate the
diagnostic performances of the indice delta ITV / delta RR.
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