Ventricular tachycardia converts to sinus rhythm after administration of propofol

Effect of Propofol in the Cardiovascular System and its Related Mechanism Research Progress

Propofol is the most widely used short-acting intravenous anesthetic in clinical practice. Existing studies have shown that propofol has many effects on the cardiovascular system in addition to its anesthetic effect. Propofol can antagonize a variety of tachyarrhythmias and reduce the risk of recurrence, regulate autonomic balance of the heart, modulate circulatory dynamics, thereby increasing blood perfusion to vital organs such as the kidney, intestine, and brain, and exert myocardial protection and cerebral protection during ischemia-reperfusion injury. In this paper, we review the potential mechanisms of these effects and provide and ideas for future research and novel drug development of propofol and its derivatives in cardiac electrophysiology and circulatory dynamics.

Emergency Management of Electrical Storm: A Practical Overview

Electrical storm is a medical emergency characterized by ventricular arrythmia recurrence that can lead to hemodynamic instability. The incidence of this clinical condition is rising, mainly in implantable cardioverter defibrillator patients, and its prognosis is often poor. Early acknowledgment, management and treatment have a key role in reducing mortality in the acute phase and improving the quality of life of these patients. In an emergency setting, several measures can be employed. Anti-arrhythmic drugs, based on the underlying disease, are often the first step to control the arrhythmic burden; besides that, new therapeutic strategies have been developed with high efficacy, such as deep sedation, early catheter ablation, neuraxial modulation and mechanical hemodynamic support. The aim of this review is to provide practical indications for the management of electrical storm in acute settings.

Propofol dose and efficacy of defibrillation testing during implantation of subcutaneous implantable cardioverter-defibrillators: A retrospective, single center cohort study

INTRODUCTION

Defibrillation testing (DFT) is recommended during subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation. Previous studies analyzing the potential interference of propofol with defibrillation threshold are inconsistent. The purpose of this study was to analyze whether propofol affects DFT post S-ICD placement.

METHODS

All patients with S-ICD implantation between 01/2017 and 11/2020 at the University Heart Center Freiburg were retrospectively analyzed. Two groups were generated depending on the success of the first shock during DFT. Implantation characteristics and dose of anesthetics were analyzed.

RESULTS

In 12 of the included 80 (15%) patients, first shock during DFT failed. The absolute dose of propofol was significantly higher in patients with first shock failure (median 653 mg [IQR 503-855]) compared to patients with first shock termination (376 mg [200-600]; p = 0.027). Doses of opioids and midazolam as well as type of anesthesia did not differ between the groups. A multivariable binary logistic regression analysis confirmed an independent association of first shock termination and propofol dose (per 100 mg: OR 0.73 (95% CI: 0.56-0.95); p = 0.021).

CONCLUSION

There is an independent association of propofol dose and first shock failure in routine S-ICD defibrillation testing.