Cardiac arrhythmia monitoring during bronchial provocation test with methacholine.
OBJECTIVE
During a bronchial provocation test (BPT), the performance of maximal inspiratory-expiratory maneuvers, causing abrupt and marked shifts in intrathoracic pressure, may increase the risk of cardiac arrhythmias. Moreover, the inhalation of methacholine (MCh), a cholinergic agonist agent, could favor the development of unwelcome cardiovascular events, namely, cardiac arrhythmias.


METHODS
We studied the number and severity of cardiac arrhythmias by ECG-Holter monitoring before, during, and after BPTs with MCh challenge in a group of 46 consecutive nonselected subjects (28 men and 18 women) with clinical indications for BPT, without preexisting cardiovascular diseases, and not receiving arrhythmogenic drugs. The subjects performed a routine pulmonary function test (PFT), followed by BPT, during ECG-Holter monitoring. Determination of the serum potassium concentration, a baseline arterial blood gas analysis, and monitoring of oxyhemoglobin saturation also were performed.


RESULTS
We found no significant increase in the number of supraventricular and ventricular arrhythmias during the performance of PFTs and of BPTs with MCh in the subjects, either with or without bronchial hyperresponsiveness (BHR). However, during the performance of BPTs, we observed a significant reduction in mean heart rate.


CONCLUSIONS
Our results indicate that the performance of PFTs and BPTs with MCh does not increase the cardiac arrhythmogenic risk in subjects without cardiovascular diseases, as well as in those with BHR, suggesting that these tests are safe to perform in most subjects.
Malerba
Mario
M
Department of Internal Medicine, University of Brescia, 1o Divisions de Medicina, Spedali Civili, piazzale Spedali Civili, 25100 Brescia, Italy. malerba@master.cci.unibs.it
Radaeli
Alessandro
A
Politi
Antonio
A
Ceriani
Luigi
L
Zulli
Roberto
R
Grassi
Vittorio
V
D000328:Adult; D001249:Asthma / Q000175:diagnosis*; D001784:Blood Gas Analysis; D016535:Bronchial Hyperreactivity / Q000175:diagnosis*; D001985:Bronchial Provocation Tests / Q000009:adverse effects* / Q000379:methods; D018679:Cholinergic Agonists / Q000009:adverse effects*; D015716:Electrocardiography, Ambulatory / Q000187:drug effects*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D016210:Methacholine Chloride / Q000009:adverse effects*; D008875:Middle Aged; D011188:Potassium / Q000097:blood; D018570:Risk Assessment; D013617:Tachycardia, Supraventricular / Q000139:chemically induced* / Q000175:diagnosis; D017180:Tachycardia, Ventricular / Q000139:chemically induced* / Q000175:diagnosis
D018679:Cholinergic Agonists; D016210:Methacholine Chloride; D011188:Potassium