Effect of electrophysiological testing on ejection fraction during cardioverter/defibrillator implantation.
To evaluate the effect of repeated induction of ventricular tachycardia or ventricular fibrillation, or both, in patients with poor left ventricular function, we performed intraoperative two-dimensional echocardiography in 6 patients undergoing implantation of the automatic implantable cardioverter/defibrillator. Changes in left ventricular ejection fraction in sinus rhythm were assessed before the first inducible ventricular arrhythmia and after a mean of 6 +/- 1.9 (SD) episodes of ventricular tachycardia or ventricular fibrillation. During the procedure no significant change in mean ejection fraction was observed (28 +/- 14 versus 27 +/- 17%). Only 1 of the 6 patients studied had a change in ejection fraction greater than 3% (a decrease from 20 to 11%). In an overall clinical series of 38 primary implants or generator changes (including electrophysiological testing) in 29 patients, 1 patient recovered after postoperative inotropic support and 1 died of acute postoperative ischemic heart failure. We conclude that ventricular arrhythmias induced during automatic implantable cardioverter/defibrillator implantation have no immediate deleterious effects on ejection fraction in most patients with compromised left ventricular function and without ongoing ischemia.
Antunes
M L
ML
Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY.
Spotnitz
H M
HM
Livelli
F D
FD
Steinberg
J S
JS
Bigger
J T
JT
D000368:Aged; D004452:Echocardiography; D004554:Electric Countershock / Q000295:instrumentation*; D004594:Electrophysiology; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume; D013610:Tachycardia / Q000503:physiopathology / Q000601:surgery*; D014693:Ventricular Fibrillation / Q000503:physiopathology*