Changes in human coronary sinus blood flow and myocardial metabolism induced by ventricular fibrillation and defibrillation
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Published on: February 17, 2023
M Runsiö1, L Bergfeldt, M Rosenqvist
1Department of Cardiothoracic Surgery, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden.
Insights
Repeated defibrillation during cardioverter-defibrillator implantation did not cause lasting myocardial metabolic issues. This study indicates the procedure is safe for heart metabolism when a 5-minute recovery is used.
Area of Science:
- Cardiology
- Physiology
- Metabolic Studies
Background:
- Implantation of cardioverter-defibrillators involves ventricular fibrillation and defibrillation.
- Myocardial metabolism during these procedures in humans is not well understood.
Purpose of the Study:
- To investigate myocardial metabolic changes during ventricular fibrillation and defibrillation in patients undergoing cardioverter-defibrillator implantation.
Main Methods:
- Blood samples analyzed for metabolic markers (lactate, glucose, etc.) from coronary sinus and radial artery.
- Coronary sinus blood flow measured in some patients.
- Measurements taken before, during, and after defibrillation episodes.
Main Results:
- Coronary sinus blood flow significantly decreased during ventricular fibrillation and increased post-defibrillation.
- Myocardial oxygen saturation and PO2 increased shortly after defibrillation.
- Transient increases in coronary sinus lactate were observed but normalized within 2 minutes.
Conclusions:
- Repeated defibrillation threshold tests with 5-minute recovery periods appear safe for myocardial metabolism.
- No long-lasting or cumulative metabolic effects were detected.
Background:
During implantation of cardioverter-defibrillators, repeated inductions of ventricular fibrillation and defibrillation are performed. Little is known about the myocardial metabolism associated with ventricular fibrillation and defibrillation in humans.
Methods:
Sixteen patients scheduled for transvenous cardioverter-defibrillator implantation were included in the study. In 10 of the patients, blood samples were taken simultaneously in the coronary sinus and radial artery and analyzed for PO2, PCO2, standard bicarbonate, pH, lactate, alanine, glucose, and glycerol. Oxygen saturation, base excess, and oxygen content were calculated. The patients were studied before, shortly after, and 2 and 5 minutes after successful defibrillation. In six of the patients, coronary sinus blood flow was registered continuously.
Results:
The coronary sinus blood flow declined from a basal value of 93 +/- 16 mL/min to 35 +/- 6 mL/min 14 +/- 2 seconds after induction of ventricular fibrillation. Following termination of ventricular fibrillation, coronary sinus blood flow increased to a peak value of 227 +/- 75 mL/min. Oxygen saturation, PO2, and oxygen content in the coronary sinus increased by approximately 25% shortly after each episode of ventricular fibrillation and defibrillation. The coronary sinus lactate increased and the arterio-coronary sinus lactate difference decreased shortly after each of the four episodes, but was normalized within 2 minutes.
Conclusions:
Repeated threshold tests during defibrillator implantation did not cause any long-lasting or cumulative metabolic effects, indicating that the described technique, with a 5-minute recovery period in between episodes, is safe as regards myocardial metabolism.
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