Effects of carbon monoxide exposure in patients with documented cardiac arrhythmias.
OBJECTIVE
This study was designed to determine whether carbon monoxide has proarrhythmic effects at rest and during upright exercise in patients with myocardial ischemia and moderate baseline ectopic activity.


BACKGROUND
Exposure of patients with documented myocardial ischemia to low levels of carboxyhemoglobin (COHb) alters the myocardial response to exercise. Anecdotal reports from patients with myocardial ischemia have noted the development of arrhythmias related to carbon monoxide exposure. Increased frequency of arrhythmias related to carbon monoxide exposure in patients performing supine bicycle exercise has been recently reported.


METHODS
Twenty-eight nonsmoking men and five nonsmoking women with documented coronary artery disease and a minimum of 30 ventricular ectopic beats/h over a 20-h period were studied. Subjects were exposed in a randomized double-blind fashion to either room air or sufficient carbon monoxide to elevate their COHb concentration to 3% or 5% in 1 h, followed by a maintenance exposure to carbon monoxide. The subjects then left the laboratory and resumed their normal daily activity to determine changes in ventricular ectopic beats after carbon monoxide exposure.


RESULTS
There was no significant change in the frequency of single ventricular ectopic beats at rest from 115 +/- 28 (in room air) to 121 +/- 31 at 3% COHb to 94 +/- 23 at 5% COHb. Exercise itself increased the frequency of ventricular ectopic beats, but there was no additional effect of carbon monoxide exposure on the exercise-induced increase in isolated ectopic beats or complex ectopic waveforms. Analysis of the data based on grouping of the subjects by the severity of disease (ventricular ectopic beat frequency, ejection fraction, presence of exercise-induced ischemia) indicated no proarrhythmic effect of carbon monoxide.


CONCLUSIONS
In patients with frequent ventricular ectopic activity (> or = 30 ectopic beats/h), exposure to carbon monoxide producing either 3% or 5% COHb does not increase arrhythmia frequency of single or multiple beats during rest or exercise.
Dahms
T E
TE
Department of Internal Medicine, Saint Louis University School of Medicine, Missouri 63110-0250.
Younis
L T
LT
Wiens
R D
RD
Zarnegar
S
S
Byers
S L
SL
Chaitman
B R
BR
D000368:Aged; D001273:Atmosphere Exposure Chambers; D002248:Carbon Monoxide / Q000633:toxicity*; D002263:Carboxyhemoglobin / Q000378:metabolism; D005117:Cardiac Complexes, Premature / Q000453:epidemiology / Q000209:etiology*; D004311:Double-Blind Method; D015716:Electrocardiography, Ambulatory; D015444:Exercise / Q000502:physiology; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000503:physiopathology*; D011897:Random Allocation; D012307:Risk Factors
D002248:Carbon Monoxide; D002263:Carboxyhemoglobin