title: Atropine first is safer than conventional atropine administration in older people undergoing dobutamine stress echocardiography.
abstract: OBJECTIVE
  Early injection of atropine during dobutamine stress echocardiography (DSE) has been demonstrated in retrospective analyses to reduce the duration and dose of dobutamine infusion, while preserving a similar diagnostic accuracy with a lower incidence of adverse effects. This study explores the safety of using atropine as a start drug before dobutamine infusion (ADSE protocol) in comparison with the conventional protocol (DASE protocol) in older patients undergoing DSE for ischemia evaluation.
  
  
  METHODS
  One hundred consecutive older patients were prospectively enrolled. When eligible, they were randomly assigned to undergo either the DASE protocol (group A, 50 patients) or the ADSE protocol (group B, 50 patients) when atropine (1.0 mg) was first administered 3 min before dobutamine infusion followed by 0.5 mg increments (maximum 1.0 mg) thereafter. Patients were monitored for adverse drug effects. Test duration was calculated.
  
  
  RESULTS
  The mean age of the whole study cohort was 67.8±4.3 years and 58 (58%) were men. Patients in group A had longer test duration (21.8±1.3 versus 13.7±0.77 min, p<0.001) and higher mean dobutamine infusion rate (39±8.2 versus 28.2±9.5 μg/kg/min, p<0.001). The two groups received a similar total dose of atropine. Group A patients showed significantly higher incidence of extrasystoles, nonsustained ventricular tachycardia and severe hypotension (p<0.05).
  
  
  CONCLUSIONS
  In older patients undergoing DSE, using atropine as a start drug, that is, adopting the ADSE protocol, is associated with shorter test duration, lower mean dobutamine infusion rate and consequently fewer adverse effects.
authors.affiliation: Department of Cardiology, Faculty of Medicine, Ain Shams University Hospital, Abbasia Square, PO 11741, Cairo, Egypt smarttmann@hotmail.com.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Shehata
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D001285:Atropine / Q000008:administration & dosage*; D004280:Dobutamine / Q000008:administration & dosage; D004334:Drug Administration Schedule; D025401:Echocardiography, Stress / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis*; D011446:Prospective Studies; D017180:Tachycardia, Ventricular / Q000453:epidemiology; D013997:Time Factors
chemical_list: D000889:Anti-Arrhythmia Agents; D004280:Dobutamine; D001285:Atropine
keywords: arrhythmias; atropine; dobutamine stress echocardiography; elderly