Recommendations for performing acetylcholine tests safely: STOP dangerous complications induced by acetylcholine tests (STOP DCIAT).
OBJECTIVE
We examined some recommendations for performing acetylcholine (ACh) tests safely.


RESULTS
We performed 1000 ACh tests from 1991 to December 2004. ACh was injected in incremental doses of 20/50/80 microg into the RCA and of 20/50/100 microg into the LCA. During these periods, we encountered various major/minor complications; 12 ventricular tachycardia (1.2%) necessary one dc, one ventricular fibrillation (0.1%) necessary dc, 3 shock like the left main stem spasm (0.3%), one cardiac tamponade necessary surgical drainage (0.1%), and 164 Paf (164/959:17.1%) necessary administration of antiarrhythmic agents to sinus rhythm in about one third patients (31.7%). We did not experience irreversible severe complications, such as acute myocardial infarction or death.


CONCLUSIONS
(1) Stand by direct current with pasting, (2) Thump version when ventricular tachycardia or fibrillation occurred, (3) Over infusion to avoid hypovolemia, (4) Perform angiography before complete spasm provocation if a severe spasm, (5) Drainage if cardiac tamponade occurred, (6) Cibenzoline or disopyramid administration when ACh induced paroxysmal atrial fibrillation, (7) Incremental ACh dose up should be performed, (8) Administer small amount of noradrenaline if shock observed and (9) Test shot should be performed before 1-min angiography.


CONCLUSIONS
We recommend STOP DCIAT for performing ACh tests safely.
Sueda
Shozo
S
Department of Cardiology, Saiseikai Saijo Hospital, 269-1 Tsuitachi, Saijo, Ehime 793-0027, Japan. EZF03146@nifty.com
Oshita
Akira
A
Nomoto
Takahiko
T
Izoe
Yousuke
Y
Kohno
Hiroaki
H
Fukuda
Hiroshi
H
Mineoi
Kazuaki
K
Ochi
Takaaki
T
Uraoka
Tadao
T
D000109:Acetylcholine / Q000009:adverse effects*; D000368:Aged; D001281:Atrial Fibrillation / Q000139:chemically induced / Q000517:prevention & control; D002305:Cardiac Tamponade / Q000139:chemically induced / Q000517:prevention & control; D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017180:Tachycardia, Ventricular / Q000139:chemically induced / Q000517:prevention & control; D014693:Ventricular Fibrillation / Q000139:chemically induced / Q000517:prevention & control
D000109:Acetylcholine