title: Cardiopulmonary effects of internal cardioverter/defibrillator implantation.
abstract: Cardiopulmonary effects of electrophysiological testing of internal cardioverter/defibrillator (ICD) devices were studied in ten patients undergoing general anaesthesia. In the control-phase, haemodynamic performance and oxygenation were slightly impaired. After completion of the electrophysiological procedures (ICD-phase), cardiopulmonary function had deteriorated significantly. Cardiac index declined by 16%, whereas left ventricular filling pressure and pulmonary vascular resistance increased (P less than or equal to 0.01). Oxygenation, but not CO2-elimination deteriorated (P less than or equal to 0.01) and venous admixture increased by 72% (P less than or equal to 0.01). Alveolo-arterial PO2-difference (PA-aO2) increased by 43% (P less than or equal to 0.01), indicating ventilation-perfusion (VA/Q) mismatching. Repeated inductions of ventricular tachycardia and/or fibrillation subject the myocardium to transient global ischaemia, leading to acute congestive heart failure, and positive inotropic intervention was necessary in 40% of the patients. Partial pulmonary insufficiency resulted possibly from interstitial oedema and VA/Q-inhomogeneities. ICD implantation has detrimental effects on haemodynamics and gas exchange in patients with impaired left ventricular function.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Westfälische Wilhelms-Universität Münster, FRG.
authors.forename: T
authors.initials: T
authors.lastname: Hachenberg
authors.forename: D
authors.initials: D
authors.lastname: Hammel
authors.forename: T
authors.initials: T
authors.lastname: Möllhoff
authors.forename: T
authors.initials: T
authors.lastname: Brüssel
authors.forename: M
authors.initials: M
authors.lastname: Block
authors.forename: M
authors.initials: M
authors.lastname: Borggrefe
authors.forename: H
authors.initials: H
authors.lastname: Haberecht
authors.forename: H H
authors.initials: HH
authors.lastname: Scheld
authors.forename: M
authors.initials: M
authors.lastname: Wendt
mesh_terms: D000368:Aged; D000769:Anesthesia, Inhalation; D004554:Electric Countershock / Q000295:instrumentation*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D011659:Pulmonary Gas Exchange / Q000502:physiology*