Incidence of cardiac arrhythmias with therapeutic versus diagnostic ultrasound and intravenous microbubbles.
OBJECTIVE
The purpose of this study was to determine the type of arrhythmias induced with therapeutic versus diagnostic transthoracic low-frequency ultrasound (TLFUS) transducers in the presence of intravenous microbubbles.


METHODS
Intravenous perfluorocarbon-exposed sonicated dextrose albumin (PESDA) microbubbles were infused or given as a bolus injection while TLFUS was applied in the standard parasternal and apical views with either a 1-MHz therapeutic ultrasound transducer or high-mechanical-index diagnostic ultrasound (1.7 MHz).


RESULTS
Significantly more ectopy was produced by the therapeutic transducer, especially at higher-intensity settings in the continuous wave mode after bolus injections of PESDA (P < .001 compared with lower intensities and lower continuous infusion rates). Six patients (15%) had either clinical supraventricular tachycardia or nonsustained ventricular tachycardia after intravenous PESDA with therapeutic TLFUS. In comparison, diagnostic high-mechanical-index ultrasound produced only isolated ventricular ectopy and no sustained ventricular arrhythmias.


CONCLUSIONS
Intravenously injected microbubbles and low-frequency therapeutic transducers operating at longer duty cycles and wide beam widths have the capability of eliciting clinically important arrhythmias in patients at high risk for such events.
Chapman
Scott
S
University of Nebraska Medical Center, Omaha, 68198-1165, USA.
Windle
John
J
Xie
Feng
F
McGrain
Anna
A
Porter
Thomas R
TR
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001145:Arrhythmias, Cardiac / Q000209:etiology*; D003287:Contrast Media / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D005466:Fluorocarbons / Q000009:adverse effects*; D005947:Glucose / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D008297:Male; D045423:Microbubbles; D008875:Middle Aged; D012709:Serum Albumin / Q000009:adverse effects; D000075462:Serum Albumin, Human; D018709:Statistics, Nonparametric; D014159:Transducers / Q000009:adverse effects; D014464:Ultrasonic Therapy / Q000009:adverse effects*; D014463:Ultrasonography / Q000009:adverse effects*
D003287:Contrast Media; D005466:Fluorocarbons; D012709:Serum Albumin; C094311:dextrose albumin solution; D005947:Glucose; D000075462:Serum Albumin, Human