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Updated: May 31, 2026
In vitro Assessment of Myocardial Protection following Hypothermia-Preconditioning in a Human Cardiac Myocytes Model
Published on: October 27, 2020
Coronary angiography and intervention during hypothermia can be performed safely without cardiac arrhythmia or
Ralf Koester1, Jan Kaehler, Achim Barmeyer
1Clinic for General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany. rkoester@uke.uni-hamburg.de
Insights
Mild therapeutic hypothermia is safe for cardiac catheterization procedures. Cardiac angiography and interventions under hypothermia did not show increased risks of vasospasm, arrhythmias, or bleeding.
Area of Science:
- Cardiology
- Critical Care Medicine
- Neuroprotection
Background:
- Mild therapeutic hypothermia is increasingly used for neuroprotection after cardiac arrest.
- Coronary angiography and percutaneous coronary interventions are frequently performed in these patients.
- Potential risks include coronary vasospasm, arrhythmias, and bleeding, necessitating safety evaluation.
Purpose of the Study:
- To evaluate the safety of cardiac catheterization under mild therapeutic hypothermia.
- To assess the incidence of vasospasm, cardiac arrhythmia, and bleeding during these procedures.
Main Methods:
- Prospective, single-center, non-interventional study.
- 29 patients undergoing cardiac catheterization (angiography or intervention) under mild hypothermia (mean 33.9°C).
- Evaluation of vasospasm, cardiac arrhythmia, and bleeding at the puncture site.
Main Results:
- No patient experienced coronary vasospasm.
- No relevant bradycardia, ventricular tachycardia, or fibrillation attributed to hypothermia.
- 100% of patients were free from vasospasm; no relevant bleeding occurred.
- Hypothermia was associated with reduced heart rate and potential hypokalemia.
Conclusions:
- Cardiac angiography and interventions under mild therapeutic hypothermia are safe in this cohort.
- Procedures were performed without hypothermia-induced vasospasm, significant rhythm events, or bleeding.
- Larger studies are needed to confirm these findings.
Purpose:
Mild therapeutic hypothermia is a neuroprotective procedure after cardiac arrest. Therefore, it is increasingly used. Likewise, there is a growing demand for coronary angiography and percutaneous coronary interventions under hypothermia. Case studies suggested that hypothermia may be associated with coronary vasospasm, heart rhythm events and platelet dysfunction. In this study, it was evaluated whether vasospasm, arrhythmia or bleeding occur to a relevant degree during cardiac catheterization under concomitant hypothermia.
Methods:
In this prospective, single-center, open-label, non-interventional study, 29 patients after resuscitation for cardiac arrest were treated with mild hypothermia and underwent cardiac catheterization (coronary angiography n = 11, coronary angiography plus percutaneous intervention n = 18). The incidence of vasospasm, cardiac arrhythmia and relevant bleeding at the puncture site were evaluated.
Results:
Mean temperature at cardiac catheterization was 33.9 ± 0.76°C. The mean heart rate was 82 ± 26 bpm at hospital admission and 67 ± 17 bpm under hypothermia (p < 0.05). There was no patient with relevant bradycardia beyond the expected hypothermia-induced rate reduction during the procedure. There were no unexpected ventricular tachycardias or episodes of ventricular fibrillation which might have been attributed to hypothermia. Twenty-nine of 29 patients (100%) were free from coronary vasospasm. There was no patient with a relevant bleeding at the puncture site. Potassium levels were low in 52% of the patients, even after resuscitation, which was partially attributed to hypothermia.
Conclusion:
Coronary angiography and percutaneous coronary interventions under mild therapeutic hypothermia were safe in this small cohort and were performed without hypothermia-induced vasospasm, relevant rhythm events or bleeding complications. This result has to be confirmed in a large series of patients.
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