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Cardioprotective effects of diltiazem infusion in the perioperative period
R Malhotra1, M Mishra, T S Kler
1Escorts Heart Institute and Research Centre, New Delhi, India. ehirc@giasdl01.vsnl.net.in
Insights
Intravenous diltiazem infusion during coronary artery bypass grafting (CABG) surgery offers superior anti-ischemic and antiarrhythmic benefits compared to nitroglycerin. This study shows diltiazem effectively controls arrhythmias without negatively impacting left ventricular function.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pharmacology
Background:
- Coronary artery bypass grafting (CABG) is a major cardiac surgery procedure.
- Perioperative myocardial ischemia and arrhythmias are significant concerns in CABG patients.
- Optimizing perioperative management is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the perioperative effects of intravenous diltiazem infusion in patients undergoing CABG.
- To assess diltiazem's efficacy as an anti-ischemic and antiarrhythmic agent.
- To determine diltiazem's impact on left ventricular function and hemodynamics.
Main Methods:
- A double-blind, randomized study involving 71 patients undergoing elective CABG.
- Patients received either diltiazem (0.1 mg/kg/h) or nitroglycerin (1 µg/kg/min) infusion for 24 hours post-cardiopulmonary bypass.
- Myocardial ischemia was monitored using Holter, ECG, and cardiac enzymes; left ventricular function was assessed via transesophageal echocardiography.
Main Results:
- Diltiazem significantly reduced postoperative heart rate and pulse pressure.
- The diltiazem group showed lower rates of transient ischemic events and coronary spasm compared to nitroglycerin.
- Postoperative atrial fibrillation, supraventricular tachycardia, and ventricular premature contractions were significantly lower in the diltiazem group.
- Transesophageal echocardiography revealed no negative inotropic effect and better preservation of diastolic function in the diltiazem group.
Conclusions:
- Intravenous diltiazem infusion provides superior anti-ischemic protection during CABG compared to nitroglycerin.
- Diltiazem demonstrates enhanced control of supraventricular arrhythmias post-CABG.
- Diltiazem infusion does not adversely affect left ventricular function, offering a safe and effective perioperative option.
Objective:
To evaluate the perioperative effects of intravenous diltiazem infusion on left ventricular functions, hemodynamics and as an anti-ischemic and antiarrhythmic agent in patients undergoing coronary artery bypass grafting (CABG).
Methods:
A double blind, randomised study was performed on 71 patients undergoing elective CABG. Infusion of diltiazem (0.1 mg/kg per h, n = 34) or nitroglycerin (1 microgram/kg per min, n = 37) was given for 24 h starting from onset of cardiopulmonary bypass. Holter monitoring, electrocardiogram and serum cardiac enzymes levels were used to diagnose myocardial ischemia. Myocardial function was assessed by perioperative transesophageal echocardiography.
Results:
The two groups did not differ with respect to preoperative and operative data. Diltiazem had no influence on hemodynamic parameters except for significant reduction in post operative heart rate and pulse pressure rate. Transient ischemic events (dilitiazem 10.2% versus nitroglycerin 33.3%, P = 0.15) and transient coronary spasm (diltiazem-6.8% versus nitroglycerin 25.9%, P = 0.15) were reduced in the diltiazem group as compared with the nitroglycerin group. The postoperative incidence of atrial fibrillation (diltiazem 3% versus nitroglycerin 22%, P = 0.03), supra ventricular tachycardia (diltiazem-3% versus nitroglycerin-22%, P = 0.03) and average ventricular premature contraction per h (diltiazem-40.2 +/- 10.2 versus nitroglycerin 53.8 +/- 12.3, P < 0.01) were significantly lower in the diltiazem group. Transesophageal echocardiography showed no significant difference in left ventricular functions and better preservation of left ventricular diastolic functions in post cardiopulmonary bypass period in diltiazem group. In addition mean deceleration time for the E wave on a 12 h post cardiopulmonary bypass period was significantly lower in the diltiazem group as compared with nitroglycerin (diltiazem 131 +/- 6 versus nitroglycerin 171 +/- 6, P < 0.01).
Conclusion:
The present study demonstrates that diltiazem infusion provides superior anti-ischemic protection and control of supraventricular arrhythmias as compared to nitroglycerin and does not produce any negative inotropic effect, as demonstrated by transesophageal echocardiography.