Randomized study of propofol effect on electrophysiological properties of the atrioventricular node in patients with nodal reentrant tachycardia.
BACKGROUND
Atrioventricular nodal reentrant tachycardia (AVNRT) is probably the most common form of paroxysmal supraventricular tachycardia. Percutaneous catheter ablation is a technique to interrupt cardiac conduction pathways selectively. The anesthetist is challenged to provide a safe anesthetic which takes into account the electrophysiologist's requirements for minimal cardiac conduction interference. Propofol is an ideal drug. However, previous studies have shown that the infusion of propofol has sometimes been associated with bradyarrhythmias or conversion of arrhythmias to sinusal rhythm. The purpose of this report is to verify the interferences of propofol in the electrophysiological properties of the atrioventricular (AV) node conduction system in patients with AVNRT.


METHODS
Patients were randomly assigned to receive either a placebo or propofol at sedative doses. An electrophysiological study was performed consisting of measuring the anterograde (AERPFP) and retrograde effective refractory period of the fast (RERPFP) and the anterograde effective refractory period of the slow (AERPSP) AV nodal pathway. Reciprocating tachycardia was induced and the cycle length (CL) and atrial-His (AH), His-ventricular (HV), and ventriculoatrial (VA) intervals were measured.


RESULTS
Propofol did not cause alteration (P > 0.05) in the AERPFP or RERPFP and the AERPSP AV nodal pathway. The AH, HV, and VA intervals were not affected. Sustained reciprocating tachycardia could be induced in the all patients. All slow pathways were successfully identified and ablated.


CONCLUSIONS
Propofol has no effect on the electrophysiological properties of the AV node conduction system. It is thus a suitable anesthetic agent for use in patients undergoing ablative procedures.
Warpechowski
Paulo
P
Institute of Cardiology of Rio Grande Do SUL/FUC, Fundação Faculdade Federal de Ciências Médicas de Porto Alegre, Porto Alegre, Brazil. pwar2002@terra.com.br
Lima
Gustavo G
GG
Medeiros
Cláudio M
CM
Santos
Ari Tadeu L
AT
Kruse
Marcelo
M
Migloransa
Marcelo H
MH
Kalil
Renato A K
RA
D000328:Adult; D001283:Atrioventricular Node / Q000187:drug effects* / Q000503:physiopathology*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D008297:Male; D015742:Propofol / Q000008:administration & dosage*; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology* / Q000601:surgery; D016896:Treatment Outcome
D006993:Hypnotics and Sedatives; D015742:Propofol