Reduction of ventricular arrhythmias by atropine during coronary arteriography.
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.
Lehmann
K G
KG
Section of Cardiology, Long Beach Veterans Administration Medical Center, Irvine, California 90822.
Chen
Y C
YC
D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000517:prevention & control*; D001285:Atropine / Q000627:therapeutic use*; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D014693:Ventricular Fibrillation / Q000209:etiology / Q000517:prevention & control
D001285:Atropine