Cardiopulmonary effects of internal cardioverter/defibrillator implantation.
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.
Hachenberg
T
T
Department of Anaesthesiology and Intensive Care Medicine, Westfälische Wilhelms-Universität Münster, FRG.
Hammel
D
D
Möllhoff
T
T
Brüssel
T
T
Block
M
M
Borggrefe
M
M
Haberecht
H
H
Scheld
H H
HH
Wendt
M
M
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*