1
|
Chouchoulis K, Chiladakis J, Koutsogiannis N, Davlouros P, Kaza M, Alexopoulos D. Impact of QT interval prolongation following antiarrhythmic drug therapy on left ventricular function. Future Cardiol 2016; 13:13-22. [PMID: 27990843 DOI: 10.2217/fca-2016-0052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM We assessed whether antiarrhythmic drug-induced QT interval prolongation affects left ventricular function. METHODS Study population included 54 patients with symptomatic recent onset atrial fibrillation spontaneously cardioverted to sinus rhythm. Electrocardiographic and echocardiographic studies were done before initiating and after achieving drug's steady state. RESULTS Significantly prolonged corrected QT interval (QTc) was noticed following only sotalol and amiodarone. The corrected precontraction time increased after sotalol (p = 0.005) and amiodarone (p = 0.017), not propafenone (p = 0.139). Analysis results between ΔEF and ΔQTc, ΔEF and ΔQTc(p), ΔE/e' and ΔQTc, ΔE/e' and ΔQTc(p) for amiodarone group were (p = 0.66, p = 0.20, p = 0.66, p = 0.33), for sotalol (p = 0.36, p = 0.51, p = 0.44, p = 0.33) and for propafenone (p = 0.38, p = 0.12, p = 0.89, p = 0.61), respectively. CONCLUSION QT interval prolongation following antiarrhythmic therapy does not affect significantly left ventricular function.
Collapse
Affiliation(s)
| | - John Chiladakis
- Cardiology Department, University Hospital of Patras, Rion, Patras, Greece
| | | | - Periklis Davlouros
- Cardiology Department, University Hospital of Patras, Rion, Patras, Greece
| | - Maria Kaza
- School of Medicine, University of Patras, Rion, Patras, Greece
| | | |
Collapse
|
2
|
ECMO for cardiac rescue in a neonate with accidental amiodarone overdose. Clin Res Cardiol 2008; 97:878-81. [DOI: 10.1007/s00392-008-0700-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Accepted: 07/07/2008] [Indexed: 11/24/2022]
|
3
|
Acute hemodynamic effects of intravenous amiodarone treatment in paediatric cardiac surgical patients. Clin Res Cardiol 2008; 97:801-10. [DOI: 10.1007/s00392-008-0683-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Accepted: 05/16/2008] [Indexed: 11/24/2022]
|
4
|
Salgado HC, Simões GM, Santana Filho VJ, Dias da Silva VJ, Salgado MCO, Fazan R. Negative inotropic and lusitropic effects of intravenous amiodarone in conscious rats. Clin Exp Pharmacol Physiol 2007; 34:870-5. [PMID: 17645632 DOI: 10.1111/j.1440-1681.2007.04676.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
1. The acute effect of amiodarone on haemodynamics (mean arterial pressure and heart rate) and ventricular function (+dP/dt(max) and -dP/dt(max)) was investigated in conscious rats. In addition, the effects of amiodarone on dobutamine stress were determined. 2. Catheters were inserted in rats into the left ventricle and femoral artery and vein. Three groups of rats received 25 or 50 mg/kg, i.v., amiodarone or vehicle (a 1:1:8 mixture of Tween 80:99.5% ethanol:distilled water), followed by dobutamine (10 microg/kg). 3. The hypotensive effect of 50 mg/kg amiodarone was combined with marked bradycardia and attenuation of +dP/dt(max) and -dP/dt(max). A slight, but significant, hypotension was caused by 25 mg/kg amiodarone, without affecting heart rate, +dP/dt(max) and -dP/dt(max). However, although both doses of amiodarone attenuated the tachycardia caused by dobutamine, neither 25 nor 50 mg/kg amiodarone affected the increase in mean arterial pressure or the enhanced response of +dP/dt(max) and -dP/dt(max). 4. In conclusion, amiodarone caused hypotension, bradycardia, negative inotropic (+dP/dt(max)) and lusitropic (-dP/dt(max)) effects in conscious rats. In addition, amiodarone attenuated the tachycardia without affecting the hypertensive, contractile (+dP/dt(max)) and lusitropic (-dP/dt(max)) responses to dobutamine stress.
Collapse
Affiliation(s)
- Helio C Salgado
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
| | | | | | | | | | | |
Collapse
|
5
|
Lessa MA, Tibiriçá E. Acute cardiodepressant effects induced by bolus intravenous administration of amiodarone in rabbits. Fundam Clin Pharmacol 2005; 19:165-72. [PMID: 15810896 DOI: 10.1111/j.1472-8206.2004.00308.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Amiodarone is a potent anti-arrhythmic with a large pharmacological spectrum that shares the mechanisms of action of all classes of anti-arrhythmic drugs. Originally used in the treatment of supraventricular arrhythmias, it has also been used to treat ventricular tachyarrhythmias. The recent inclusion of amiodarone in the Advanced Cardiac Life Support protocols warrants the characterization of the hemodynamic profile resulting from the rapid venous administration of the drug. Thus, the main purpose of the present study was to investigate the acute hemodynamic profile resulting from the bolus i.v. injection of amiodarone, compared with bolus i.v. administration of lidocaine. We investigated the acute hemodynamic effects of amiodarone and lidocaine, in an experimental model of open-chest pentobarbital-anesthetized rabbits (n = 24). Amiodarone (5 mg/kg) induced immediate reductions in mean arterial pressure (MAP) of 32 +/- 5% (P < 0.001), accompanied by reductions in cardiac contractility and relaxation, as assessed by left ventricular (LV) +dP/dt(max) and -dP/dt(max) (40 +/- 4 and 36 +/- 4% respectively) (P < 0.001), heart rate (HR) 10 +/- 1% (P < 0.05), cardiac output (CO) 24 +/- 5% (P < 0.001) and systemic vascular resistance (SVR) 19 +/- 3.5% (P < 0.05). Lidocaine (3 mg/kg) induced reductions in: MAP of 18 +/- 7% (P < 0.001), LV +dP/dt(max) and -dP/dt(max) (40 +/- 5 and 22 +/- 7% respectively) (P < 0.001), HR 7 +/- 1% (P < 0.01) and CO of 23 +/- 6% (P < 0.001). SVR increased by 9 +/- 1.5% (P > 0.05). It is concluded that rapid i.v. administration of both amiodarone and lidocaine induces significant cardiovascular depression mainly characterized by immediate reductions in cardiac contractility.
Collapse
Affiliation(s)
- Marcos Adriano Lessa
- Departamento de Fisiologia e Farmacodinâmica, Instituto Oswaldo Cruz, FIOCRUZ. Av. Brasil 4365, C.P. 926, 21045-900 Rio de Janeiro, Brazil
| | | |
Collapse
|
6
|
Cheung AT, Weiss SJ, Savino JS, Levy WJ, Augoustides JG, Harrington A, Gardner TJ. Acute circulatory actions of intravenous amiodarone loading in cardiac surgical patients. Ann Thorac Surg 2003; 76:535-41. [PMID: 12902100 DOI: 10.1016/s0003-4975(03)00509-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The duration, severity, and cause of hypotension after intravenous amiodarone has not been well characterized in anesthetized cardiac surgical patients. Because amiodarone is tolerated in patients with advanced cardiac disease, we hypothesized that left ventricular systolic performance is preserved despite hypotension during amiodarone loading. METHODS In a prospective double-blind trial, 30 patients undergoing coronary artery bypass graft (CABG) surgery were randomly assigned to receive intravenous amiodarone (n = 15) or placebo (n = 15). Cardiac output (CO), mixed venous oxygen saturation (SVO), arterial blood pressure (systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial pressure [MAP]), pulmonary artery pressure, and central venous pressure (CVP) were recorded. Transesophageal echocardiographic left ventricular end-diastolic area (EDA), end-systolic area (ESA), fractional area change (FAC), and end-systolic wall stress (ESWS) were measured every 5 minutes. RESULTS Mean arterial pressure, SBP, and DBP decreased over time after drug administration in both groups (p < 0.05). At 6 minutes, amiodarone decreased the MAP by 14 mm Hg (p = 0.004) and placebo decreased the MAP by 4 mm Hg. The change in MAP, SBP, and DBP between groups was statistically different for the first 15 minutes after drug administration. Hypotension requiring intervention occurred in 3 of 15 after amiodarone and 0 of 15 after placebo (p = 0.22). The mean heart rate was 11.5 beats per minute less after amiodarone (p < 0.02), but pulmonary artery pressure, CVP, SVO, and FAC were not different between groups. CONCLUSIONS Intravenous amiodarone decreased heart rate and caused a significant, but transient decrease in arterial pressure in the first 15 minutes after administration. Left ventricular performance was maintained suggesting that selective arterial vasodilation was the primary cause of drug-induced hypotension.
Collapse
Affiliation(s)
- Albert T Cheung
- Department of Anesthesiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104-4283, USA.
| | | | | | | | | | | | | |
Collapse
|
7
|
Kolb C, Lehmann G, Schreieck J, Ndrepepa G, Schmitt C. Storms of ventricular tachyarrhythmias associated with primary hyperparathyroidism in a patient with dilated cardiomyopathy. Int J Cardiol 2003; 87:115-6. [PMID: 12468064 DOI: 10.1016/s0167-5273(02)00314-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
8
|
Dias da Silva Valdo J, Viana Públio CC, de Melo Alves R, Fazan R, Ruscone TG, Porta A, Malliani A, Salgado HC, Montano N. Intravenous amiodarone modifies autonomic balance and increases baroreflex sensitivity in conscious rats. Auton Neurosci 2002; 95:88-96. [PMID: 11871788 DOI: 10.1016/s1566-0702(01)00365-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Amiodarone is an antiarrhythmic agent commonly used to treat cardiac arrhythmias. This study was designed to investigate the effects of intravenous amiodarone on the neural control of heart rate and arterial pressure and spontaneous baroreflex sensitivity (BRS). Experiments were carried out on conscious freely moving normotensive Wistar (WR) and spontaneously hypertensive rats (SHR). Arterial pressure was continuously monitored before and after amiodarone (50 mg/kg i.v.) or vehicle for 30 min. Heart rate (expressed as the pulse interval, PI) and systolic arterial pressure (SAP) variabilities were assessed using autoregressive spectral analysis. BRS was calculated as the alpha-index (the square root of the ratio between the PI and SAP powers). Amiodarone induced bradycardia and hypotension in both strains, with these effects being more intense in SHR. The variability profile of PI was characterized by a significant reduction of normalized low frequency (LF) and LF/HF ratio, while the high frequency (HF) component both in absolute and normalized units (nu) was increased in both WR and SHR strains. A significant decrease in SAP variance and its LF oscillation was observed. In addition, BRS was also increased in both groups, being more intense in SHR. In both WR and SHR, intravenous amiodarone had a considerable effect on heart rate variabilities (HRV), shifting cardiac sympathovagal balance toward a sympathetic inhibition and/or vagal activation, which were associated with an increase in spontaneous BRS. Decreases of SAP variance and LF(SAP) suggest sympatholytic effects on peripheral vessels. Besides the direct ion channel effects, these changes in the autonomic balance could contribute to the antiarrhythmic action of the intravenous amiodarone.
Collapse
Affiliation(s)
- José Dias da Silva Valdo
- Department of Biological Sciences, School of Medicine of Triangulo Mineiro, Uberaba (MG), Brazil
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Dias Da Silva VJ, Cavalcante Viana PC, de Melo Alves R, Salgado HC, Montano N, Fazan R. Antihypertensive action of amiodarone in spontaneously hypertensive rats. Hypertension 2001; 38:597-601. [PMID: 11566938 DOI: 10.1161/hy09t1.096187] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The antihypertensive effect of amiodarone was investigated in spontaneously hypertensive rats (SHR) and normotensive Wistar-Kyoto rats (WKY). The SHR and WKY were treated with amiodarone (1 mg/mL PO) or tap water (control) for 20 weeks. The indirect arterial pressure (AP) was monitored weekly using the tail-cuff method. At the end of the 20th week, the direct AP was measured, and the systolic AP and pulse interval time series were submitted to autoregressive spectral analysis. In addition, cardiac baroreflex sensitivity and left ventricular weight were evaluated as well. The indirect AP was reduced 1 week after the beginning of amiodarone treatment. The direct mean AP and pulse interval were, respectively, 135+/-8 mm Hg and 191+/-3 ms in SHR treated with amiodarone (187+/-8 mm Hg and 156+/-7 ms in control SHR, P<0.05) and 87+/-3 mm Hg and 207+/-8 ms in WKY treated with amiodarone (105+/-8 mm Hg and 174+/-4 ms in control WKY, P<0.05). In SHR treated with amiodarone, the low-frequency oscillations of AP were lower (8.5+/-1.2 mm Hg(2) versus 14.4+/-2.9 mm Hg(2) in control SHR, P<0.05), whereas the reflex bradycardia was higher (0.84+/-0.12 ms/mm Hg versus 0.32+/-0.22 ms/mm Hg in control SHR, P<0.05). The left ventricle weight was also smaller in SHR treated with amiodarone (2.94+/-0.12 mg/g versus 3.45+/-0.24 mg/g in control SHR, P<0.05). In WKY, amiodarone induced similar changes as in SHR, except for a lack of effect in the left ventricle weight. These data indicate that amiodarone has an antihypertensive action in SHR that is associated with a reduction in vasomotor sympathetic modulation, an increase in vagal cardiac baroreflex sensitivity, and a decrease in cardiac hypertrophy.
Collapse
Affiliation(s)
- V J Dias Da Silva
- Department of Biological Sciences, School of Medicine of Triângulo Mineiro, Uberaba, MG, Brazil.
| | | | | | | | | | | |
Collapse
|
10
|
Evans-Murray A. Wolff Parkinson White (WPW) syndrome: what the critical care nurse needs to consider when administering antiarrhythmics. Aust Crit Care 2001; 14:5-9. [PMID: 11899759 DOI: 10.1016/s1036-7314(01)80016-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
This paper discusses the importance of critical care and emergency nurses having an understanding of why pre-existing cardiac disorders can influence antiarrhythmic treatment. The patient with a pre-excitation syndrome is usually managed in a coronary care unit. However, these patients may be admitted to an intensive care unit (ICU) with complications of Wolff Parkinson White (WPW) syndrome; for example post cardiopulmonary arrest or WPW as a co-morbidity. It is common practice in critical care areas for registered nurses to administer antiarrhythmics without a doctor's prescription in life-threatening situations. Therefore, the critical care nurse must have knowledge of the implications of administering standard antiarrhythmic agents if this patient reverts into a tachyarrhythmia. If antiarrhythmics are administered that are contraindicated in patients with WPW syndrome, then there is potential for deleterious effects. This case study highlights the different pharmacological agents for treating tachyarrhythmias in a patient with WPW syndrome. The paper outlines the correct treatment and discusses the deleterious effects of incorrect administration of drugs in WPW syndrome.
Collapse
Affiliation(s)
- A Evans-Murray
- Critical Care Division, Gold Coast Hospital/Griffith University, QLD
| |
Collapse
|
11
|
Auricchio A, Nisam S, Klein HU. Perspectives: does amiodarone increase non-sudden deaths? If so, why? J Interv Card Electrophysiol 2000; 4:569-74. [PMID: 11141201 DOI: 10.1023/a:1026505329169] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Despite the antiarrhythmic efficacy of amiodarone, a definitive correlation between amiodarone treatment and increased non-arrhythmic mortality in patients with heart failure and depressed ventricular function has been reported. Results from research in the field of cardiac resynchronization therapy in heart failure may provide some explanations to this observation. We discussed the hypothetical link between amiodarone and non-arrhythmic mortality, which might have a cause--effect relationship, based on cardiac electromechanical disarrangement provoked by electrophysiological properties of amiodarone.
Collapse
Affiliation(s)
- A Auricchio
- Department of Cardiology, University Hospital, Magdeburg, Germany.
| | | | | |
Collapse
|
12
|
DeCara JM, Pollak A, Dubrey S, Falk RH. Positive atrial inotropic effect of dofetilide after cardioversion of atrial fibrillation or flutter. Am J Cardiol 2000; 86:685-8, A8. [PMID: 10980226 DOI: 10.1016/s0002-9149(00)01044-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The pure class III agent dofetilide was evaluated to determine its effect on atrial function after cardioversion of atrial fibrillation or flutter. Compared with placebo, dofetilide-treated patients had evidence of better atrial function after cardioversion, indicating that this agent has a positive atrial inotropic effect during the period of postcardioversion atrial stunning.
Collapse
Affiliation(s)
- J M DeCara
- Boston Medical Center, Massachusetts 02118, USA
| | | | | | | |
Collapse
|
13
|
Djandjighian L, Planchenault J, Finance O, Pastor G, Gautier P, Nisato D. Hemodynamic and antiadrenergic effects of dronedarone and amiodarone in animals with a healed myocardial infarction. J Cardiovasc Pharmacol 2000; 36:376-83. [PMID: 10975596 DOI: 10.1097/00005344-200009000-00014] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The hemodynamic and antiadrenergic effects of dronedarone, a noniodinated compound structurally related to amiodarone, were compared with those of amiodarone after prolonged oral administration, both at rest and during sympathetic stimulation in conscious dogs with a healed myocardial infarction. All dogs (n = 6) randomly received orally dronedarone (10 and 30 mg/kg), amiodarone (10 and 30 mg/kg), and placebo twice daily for 7 days, with a 3-week washout between consecutive treatments. Heart rate (HR), mean arterial pressure (MBP), positive rate of increase of left ventricular pressure (+LVdP/dt), echocardiographically assessed left ventricular ejection fraction (LVEF), and fractional shortening (FS), as well as chronotropic response to isoproterenol and exercise-induced sympathetic stimulation were evaluated under baseline and posttreatment conditions. Resting values of LVEF, FS, +LVdP/dt, and MBP remained unchanged whatever the drug and the dosing regimen, whereas resting HR was significantly and dose-dependently lowered after dronedarone and to a lesser extent after amiodarone. Both dronedarone and amiodarone significantly reduced the exercise-induced tachycardia and, at the highest dose, decreased the isoproterenol-induced tachycardia. Thus, dronedarone and amiodarone displayed a similar level of antiadrenergic effect and did not impair the resting left ventricular function. Consequently, dronedarone might be particularly suitable for the treatment and prevention of various clinical arrhythmias, without compromising the left ventricular function.
Collapse
Affiliation(s)
- L Djandjighian
- Cardiovascular/Thrombosis Research Department, Sanofi-Synthelabo, Montpellier, France.
| | | | | | | | | | | |
Collapse
|
14
|
Cada DJ, Baker DE, Levien T. Dofetilide. Hosp Pharm 2000. [DOI: 10.1177/001857870003500506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Each month, subscribers to The Formulary® Monograph Service receive five to six researched monographs on drugs that are newly released or are in late Phase III trials. The monographs are targeted to your Pharmacy and Therapeutics Committee. Subscribers also receive monthly one-page summary monographs on the agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation (DUE) is also provided each month. The monographs are published in printed form and on diskettes that allow customization. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board called The Formulary Information Exchange (The F.I.X). All topics pertinent to clinical pharmacy are discussed on The F.I.X. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The May 2000 Formulary monographs are linezolid, pneumococcal 7-valent conjugate vaccine, apomorphine, levobetaxolol HCl, mequinol 2% and tretinoin 0.1% topical solution. The DUE is on dexmedetomidine.
Collapse
Affiliation(s)
- Dennis J. Cada
- The Formulary, Washington State University at Spokane, 601 West First Avenue, Spokane, WA 99201-3899
| | - Danial E. Baker
- Drug Information Center, Washington State University at Spokane, 601 West First Avenue, Spokane, WA 99201-3899
| | - Terri Levien
- College of Pharmacy, Washington State University at Spokane, 601 West First Avenue, Spokane, WA 99201-3899
| |
Collapse
|
15
|
Kini A, Marmur JD, Duvvuri S, Dangas G, Choudhary S, Sharma SK. Rotational atherectomy: improved procedural outcome with evolution of technique and equipment. Single-center results of first 1,000 patients. Catheter Cardiovasc Interv 1999; 46:305-11. [PMID: 10348127 DOI: 10.1002/(sici)1522-726x(199903)46:3<305::aid-ccd9>3.0.co;2-u] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We present our single-center experience of rotational atherectomy (RA) in the first 1,000 consecutive patients divided arbitrarily into three different time periods corresponding to significant changes in technique or equipment for RA. Period I (August 1994 to April 1995; 172 cases) is characterized by early experience, longer ablation, and frequent use of intra-aortic balloon pump; period II (May 1995 to January 1996; 254 cases) is characterized by short ablation runs (20-30 sec) and use of rotaflush; period III (February 1996 to February 1997; 574 cases) is characterized by ReoPro use, neosynephrine boluses to avoid hypotension, and rota floppy wire and flexible shaft burrs. The procedural success rate has improved and complication rates have progressively declined over these three time periods. The incidence of lesion complexity (long and type C lesions) and patients with unstable rest angina have increased over these time periods of RA. Therefore, modification in procedural techniques and equipment over time have made RA a safe technique despite its use in very complex lesion subsets.
Collapse
Affiliation(s)
- A Kini
- Cardiac Catheterization Laboratory of the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, NY 10029, USA
| | | | | | | | | | | |
Collapse
|