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Reduction of ventricular arrhythmias by atropine during coronary arteriography
1Section of Cardiology, Long Beach Veterans Administration Medical Center, Irvine, California 90822.
Insights
Prophylactic atropine sulfate may significantly reduce the risk of ventricular arrhythmias during coronary angiography. This finding suggests a potential protective role for atropine in preventing this serious cardiac complication.
Area of Science:
- Cardiology
- Clinical Trials
- Pharmacology
Background:
- Sustained ventricular arrhythmia is a known complication of cardiac catheterization, particularly after selective coronary artery contrast injection.
- The role of autonomic reflexes in this arrhythmia's development is not fully understood.
- Atropine, a muscarinic antagonist, is used to prevent bradycardia but its effect on ventricular arrhythmias is unestablished.
Purpose of the Study:
- To investigate the influence of atropine sulfate on the occurrence of ventricular arrhythmias during coronary arteriography.
- To determine if prophylactic atropine administration impacts the incidence of sustained ventricular tachyarrhythmia.
Main Methods:
- A case-control trial involving 648 patients undergoing coronary arteriography.
- Eleven cases of ventricular tachyarrhythmia were identified and matched with control subjects.
- Statistical analysis compared the incidence of arrhythmias based on various factors, including atropine administration and contrast injection site.
Main Results:
- Ventricular tachyarrhythmias were more frequent after selective right coronary injection (OR 15.1, p=0.0008).
- Prophylactic atropine sulfate was administered to 55% of controls but only 9% of cases (OR 12.0, p=0.02).
- The odds of experiencing ventricular tachyarrhythmias were potentially reduced 12-fold by prior atropine administration.
Conclusions:
- Prior administration of atropine sulfate may significantly reduce the likelihood of sustained ventricular tachyarrhythmias during coronary arteriography.
- This protective effect was observed even in patients with normal baseline heart rates.
- Atropine's role in preventing arrhythmias during cardiac procedures warrants further investigation.
Abstract:
Sustained ventricular arrhythmia is a well-recognized complication of cardiac catheterization, often occurring after selective coronary artery injection of contrast medium. The role of autonomic reflexes in the pathogenesis of this phenomenon is unclear. Although the muscarinic antagonist atropine is often administered prophylactically before coronary angiography to reduce the likelihood of sinus bradycardia and vasovagal reactions, its influence on ventricular arrhythmias in this setting has not been established. This case-control trial studied 648 patients undergoing coronary arteriography to investigate this issue. Eleven case subjects (those with ventricular tachyarrhythmia) were identified. Control subjects (those without ventricular tachyarrhythmia) were matched for baseline heart rate (+/- 6 beats/min), age (+/- 10 years), sex and calendar year of procedure using a 1:3 sampling ratio. All 26 potential clinical, anatomic and hemodynamic covariates were statistically similar between groups. Ventricular tachyarrhythmias were more likely to occur after selective right coronary injection (odds ratio 15.1, p = 0.0008) but not after multiple contrast injections (odds ratio 0.918, difference not significant). Most importantly, atropine sulfate was administered prophylactically to 18 of 33 control subjects (55 +/- 9%) but only 1 of 11 cases (9 +/- 9%), generating a significant odds ratio of 12.0 (p = 0.02). Thus, the odds of experiencing sustained ventricular tachyarrhythmias during coronary arteriography may potentially be reduced 12-fold by prior administration of atropine, even in patients with normal baseline heart rates.