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Ramanna H, Lloret JL, Zahwe F, Porterfield C, Trines S, Djajadisastra I, Gibson D, Gururaj A, Alizadeh Dehnavi R, Raine D, James S, Razak E, Oommen S, Tao C, Olson N. P1383Procedural differences during de novo paroxysmal atrial fibrillation ablation with a contact force-sensing ablation catheter between Europe and U.S. Europace 2020. [DOI: 10.1093/europace/euaa162.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Although pulmonary vein isolation (PVI) is considered the standard approach of atrial fibrillation ablation worldwide, procedural practice during the ablation varies by geographical region. Using the same magnetic sensor enabled contact force-sensing ablation catheter for the treatment of de novo paroxysmal atrial fibrillation, a comparison of procedural detail between Europe and U.S operators can provide insights into geographic specific clinical practices.
Purpose
To characterize and compare procedural differences during paroxysmal atrial fibrillation ablation performed with a magnetic sensor enabled contact force-sensing catheter across European and U.S. centers.
Methods
Procedural data were prospectively collected in clinical cases performed with a new magnetic sensor enabled, contact force ablation catheter within the first 6 months of use at participating centers in Europe and the U.S. Procedure time, PVI time, PVI confirmation method, fluoroscopy usage and lesion delivery parameters were analyzed based on geographies.
Results
A total of 131 cases across 35 centers in 11 European countries, and 95 cases across 26 U.S. centers were analyzed. Target geometry was created with the ablation catheter in 94 out of 131 (71.8%) European cases, while only 5 out of 95 U.S. cases (5.3%) reported the use of the ablation catheter for model creation. Although a steerable sheath (64.1% and 67.3%) was commonly used with the ablation catheter in both geographies, difference in the utilization of bidirectional contact force catheter (52.7% and 90.5%) and the automated lesion marking module (76.3% and 81.1%) were observed in European and U.S. cases, respectively. The use of adenosine or isoproterenol to confirm PVI was reported in 25% and 64% of the European and U.S. cases. Average waiting periods were 18.2 minutes and 26.5 minutes from reported European and U.S. cases. Total procedural time, mapping time, and fluoroscopy time were similar between European and U.S. cases. (Table). First pass PVI were 66.4% and 72.6% for European and U.S. cases, respectively.
Conclusion
Total procedural time and RF time were similar between European and U.S. cases during de novo paroxysmal atrial fibrillation ablation using the same ablation catheter. Differences in workflow including the use of a mapping catheter for geometry creation and waiting period were observed between the two geographies.
Summary of procedural details De novo PAF N Procedural time(min) Mapping time (min) PVI time (min) Total RF time (min) Fluoro time( min) Europe 131 144.0 ± 56.9 16.6 ± 17.1 69.8 ± 35.0 33.2 ± 15.6 11.6 ± 10.1 U.S. 95 137.6 ± 64.8 18.1 ± 23.5 58.8 ± 31.5 32.3 ± 22.2 12.0 ± 15.8
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Affiliation(s)
- H Ramanna
- Hage Ziekenhuis, Den Haag, Netherlands (The)
| | - J L Lloret
- Hôpital privé A Tzanck Mougins Sophia Antipolis , Mougins, France
| | - F Zahwe
- Michigan Heart Rhythm Center, Dearborn, United States of America
| | - C Porterfield
- French Hospital Medical Center, San Luis Obispo, United States of America
| | - S Trines
- Leiden University Medical Center, Heart Lung Centre, Leiden, Netherlands (The)
| | | | - D Gibson
- Scripps Clinic and Prebys Cardiovascular Institute, La Jolla, United States of America
| | - A Gururaj
- Desert Springs Hospital, Las Vegas, United States of America
| | | | - D Raine
- Norfolk and Norwich University Hospital, Norwich, United Kingdom of Great Britain & Northern Ireland
| | - S James
- James Cook University Hospital, Middlesbrough, United Kingdom of Great Britain & Northern Ireland
| | - E Razak
- St. Joseph Medical Center, Tacoma, United States of America
| | - S Oommen
- John Muir Medical Center Concord, Concord, United States of America
| | - C Tao
- Abbott, Minneapolis, United States of America
| | - N Olson
- Scripps Memorial Hospital La Jolla, La Jolla, United States of America
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Ramanna H, Lloret JL, Zahwe F, Porterfield C, Trines S, Djajadisastra I, Gibson D, Gururaj A, Alizadeh Dehnavi R, Raine D, James S, Razak E, Oommen S, Tao C, Olson N. P981Comparison of automark utilization and lesion metric target during paroxysmal atrial fibrillation ablation with a contact force-sensing ablation catheter: European and U.S. multicenter Experiences. Europace 2020. [DOI: 10.1093/europace/euaa162.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Accurate delivery of transmural lesion is associated with improved durability of pulmonary vein isolation and reduced reconduction. Lesion quality depends on multiple parameters such as radiofrequency power, tissue-catheter contact, duration of energy application, and catheter tip temperature. Consequently, energy delivery parameters vary based on individual operators’ preferences and procedural needs.
Purpose
To characterize and compare the utilization of automated lesion marking feature and lesion delivery parameters used during paroxysmal atrial fibrillation ablation performed with a magnetic sensor enabled contact force-sensing catheter across European and U.S. centers.
Methods
Procedural data were prospectively collected in clinical cases performed with a new magnetic sensor enabled, contact force ablation catheter within the first 6 months of use at participating centers in Europe and the U.S. Use of bidirectional CF catheters, steerable sheaths, automated lesion marking software and associated lesion delivery parameters during paroxysmal atrial fibrillation ablation were evaluated.
Results
A total of 149 cases across 37 centers in 11 European countries, and 112 cases across 31 U.S. centers were analyzed. A bidirectional contact force catheter (56.4% and 90.2%), a steerable sheath (65.8% and 69.6%), and the automated lesion marking module (77.9% and 90.2%) were used in most European and U.S. cases, respectively. The most commonly reported energy delivery parameters were: lesion index (LSI), Force-Time Integral (FTI), and time from European cases; LSI, average force, and FTI for U.S. cases (Table). Target LSI values were recorded for 126 cases in Europe and 34 in the U.S, ranging from 3 to 6. In anterior/roof segments, most common LSI target values for anterior/roof and posterior/inferior segments were 6 (42.9%) and 5 (51.2%) in Europe, and 5.5 (44.1%) and 5 (54.5%) in the U.S. PVI was confirmed with an average of 20.3 minutes waiting period (69.1%) for European cases and exit block (57.1%) in U.S. cases. First pass PVI were 67.1% and 74.4% for European and U.S. cases, respectively.
Conclusion
Energy delivery parameters and PVI confirmation method varied considerably by geography during paroxysmal atrial fibrillation ablation using the magnetic sensor enabled, contact force ablation catheter. Further study on efficacy implication on these differences in practice should be examined.
Energy delivery parameters used Paroxysmal AF N LSI FTI Time Imp Drop Avg Force Other N/A Europe 149 44.0 % 13.4 % 7.0 % 6.0 % 2.4 % 1.0 % 26.2 % U.S. 112 31.2% 17.9 % 6.2 % 8.0 % 23.2 % 11.7 % 1.8 % Energy delivery parameters used in paroxysmal AF ablation in Europe and U.S.
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Affiliation(s)
- H Ramanna
- Hage Ziekenhuis, Den Haag, Netherlands (The)
| | - J L Lloret
- Hôpital privé A Tzanck Mougins Sophia Antipolis , Mougins, France
| | - F Zahwe
- Michigan Heart Rhythm Center, Dearborn, United States of America
| | - C Porterfield
- French Hospital Medical Center, San Luis Obispo, United States of America
| | - S Trines
- Leiden University Medical Center, Heart Lung Centre, Leiden, Netherlands (The)
| | | | - D Gibson
- Scripps Clinic and Prebys Cardiovascular Institute, La Jolla, United States of America
| | - A Gururaj
- Desert Springs Hospital, Las Vegas, United States of America
| | | | - D Raine
- Norfolk and Norwich University Hospital, Norwich, United Kingdom of Great Britain & Northern Ireland
| | - S James
- James Cook University Hospital, Middlesbrough, United Kingdom of Great Britain & Northern Ireland
| | - E Razak
- St. Joseph Medical Center, Tacoma, United States of America
| | - S Oommen
- John Muir Medical Center Concord, Concord, United States of America
| | - C Tao
- Abbott, Minneapolis, United States of America
| | - N Olson
- Scripps Memorial Hospital La Jolla, La Jolla, United States of America
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James S, Lloret JL, Trines S, Raine D, Dehnavi RA, Jensen H, Lukac P, Gora P. P362AutoMark utilization and lesion metric targets: a multicenter European experience. Europace 2018. [DOI: 10.1093/europace/euy015.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S James
- James Cook University Hospital, Middlesborough, United Kingdom
| | - J L Lloret
- Clinique de l'Espérance, Mougins, France
| | - S Trines
- Leiden University Medical Center, Leiden, Netherlands
| | - D Raine
- John Radcliffe Hospital, Oxford, United Kingdom
| | - R A Dehnavi
- Leiden University Medical Center, Leiden, Netherlands
| | - H Jensen
- Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - P Lukac
- Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - P Gora
- Abbott, Minneapolis, United States of America
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Lloret JL, James S, Trines S, Dehnavi RA, Merino JL, Raine D, Clappers N, Jones D, Pisapia A, Gora P. P367Early European experience with a magnetic sensor enabled contact force-sensing catheter. Europace 2018. [DOI: 10.1093/europace/euy015.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J L Lloret
- Clinique de l'Espérance, Mougins, France
| | - S James
- James Cook University Hospital, Middlesborough, United Kingdom
| | - S Trines
- Leiden University Medical Center, Leiden, Netherlands
| | - R A Dehnavi
- Leiden University Medical Center, Leiden, Netherlands
| | - J L Merino
- University Hospital La Paz, Madrid, Spain
| | - D Raine
- John Radcliffe Hospital, Oxford, United Kingdom
| | - N Clappers
- University Medical Center Utrecht, Utrecht, Netherlands
| | - D Jones
- Harefield Hospital, London, United Kingdom
| | - A Pisapia
- St. Joseph Hospital of Marseille, Marseille, France
| | - P Gora
- Abbott, Minneapolis, United States of America
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Raine D, Lee A, Wiedmann R. Flash pulmonary oedema: a rare but serious side effect of quinine sulphate. Case Reports 2012; 2012:bcr.03.2011.4040. [DOI: 10.1136/bcr.03.2011.4040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Oppong K, Raine D, Nayar M, Wadehra V, Ramakrishnan S, Charnley RM. EUS-FNA versus biliary brushings and assessment of simultaneous performance in jaundiced patients with suspected malignant obstruction. JOP 2010. [PMID: 21068487 DOI: 10.6092/1590-8577/3398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
CONTEXT Individuals with suspected malignant biliary obstruction commonly undergo ERCP for drainage and tissue sampling via biliary brushings. EUS with EUS-FNA facilitates staging and potentially more accurate tissue sampling. OBJECTIVE The aim is to compare the diagnostic performance of EUS-FNA and ERCP with biliary brushings (ERCP-BB) in the diagnosis of pancreatobiliary carcinoma and the utility of combining the two procedures under conscious sedation. DESIGN Retrospective analysis of a prospectively maintained database. PATIENTS Thirty-seven patients with suspected malignant obstructive jaundice underwent 39 paired procedures, either combined (n=22) or within a few days (n=17). RESULTS Using strict cytological criteria the sensitivity of EUS-FNA in the diagnosis of malignancy was 52.9% (95% CI: 35.1-70.2%) versus 29.4% (95% CI: 15.1-47.5%) for ERCP-BB. Combining the two tests improved sensitivity to 64.7% (95% CI: 46.5-80.3%) which was significantly better than ERCP-BB alone (P=0.001) but not EUS-FNA alone (P=0.125). When both procedures were performed under the same conscious sedation, there was a significant difference (P=0.031) between the sensitivity of EUS-FNA (52.6%; 95% CI: 28.9-75.6%) and that of ERCP-BB (21.1%; 95% CI: 6.1-45.6%). When both procedures were performed together the mean±SD in-room time was 79±14 min (range: 45-105 min). Two of the patients (9.1%) had a complication. CONCLUSIONS In patients undergoing EUS-FNA and ERCP-BB under the same sedation, EUS-FNA was significantly more sensitive in diagnosing malignancy. Combining the results of both tests improved diagnostic accuracy. Combining therapeutic ERCP and EUS-FNA under the same conscious sedation is feasible, with a complication rate similar to that of ERCP alone.
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Affiliation(s)
- Kofi Oppong
- Department of Gastroenterology, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
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Abstract
BACKGROUND The importance of antinucleolar antibodies seen by indirect immunofluorescence on HEp-2 cells, although associated with systemic sclerosis (SSc), in unselected patients is unknown. AIMS To determine the true clinical significance of antinucleolar antibodies in an unselected patient population. METHODS Antinucleolar antibody (ANoA) positive samples were identified in the immunology laboratory during routine autoimmune screening tests; case notes were reviewed using a standard proforma. RESULTS 104 patients with ANoA were identified and ANoA+ samples were subclassified into homogeneous, clumpy and speckled antinucleolar types. SSc was evident in only two (1.8%) patients. Other connective tissue diseases were identified in 33 patients (32%); 22 patients (21%) had evidence of various malignancies. Both disordered liver function and anaemia were seen in 22 patients and were the commonest laboratory abnormalities. CONCLUSIONS Neither the presence nor subtype of ANoA is specific for systemic sclerosis. Laboratory comments appended to results should reflect this fact.
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Affiliation(s)
- S Khan
- Path Links Immunology, Scunthorpe General Hospital, Scunthorpe, UK.
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Raine D, Langley P, Murray A, Furniss SS, Bourke JP. Surface atrial frequency analysis in patients with atrial fibrillation: assessing the effects of linear left atrial ablation. J Cardiovasc Electrophysiol 2005; 16:838-44. [PMID: 16101624 DOI: 10.1111/j.1540-8167.2005.40456.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Our group has shown previously that measurements of atrial frequency can be obtained from surface 12-lead ECG recordings of patients during atrial fibrillation (AF), using a combination of principal component and Fourier transform algorithms. Such measurements are reproducible over time and change with drug manipulation of the arrhythmia. AIMS To determine whether linear left atrial ablation, using a combination of "roof" and "mitral isthmus" lines results in changes in surface atrial frequency during AF and to assess the contribution of each individual line when sited sequentially. METHODS AND RESULTS Computerized recordings from 26 patients, who had undergone linear ablation procedures for AF, were reviewed. The atrial signal was extracted from the 12-lead ECG data by principal component analysis and the main frequency component identified using Fourier analysis. Atrial frequency before and after these two standard ablation lines was compared. Atrial frequency decreased significantly after the combination of roof and mitral isthmus lines (5.66 vs 5.15 Hz) and when either roof (5.61 vs 5.13 Hz) or mitral isthmus (5.89 vs 5.75 Hz) lines were sited first. However, only the roof line led to a significant reduction in atrial frequency when sited second (5.64 vs 5.49 Hz). CONCLUSIONS Measurements of atrial frequency can be obtained from surface 12-lead ECG recordings during AF and change as predicted in response to linear left atrial ablation. This technique may be useful in assessing antiarrhythmic treatments for AF.
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Affiliation(s)
- Dan Raine
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Trust, UK. D.T.
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Raine D, Langley P, Murray A, Dunuwille A, Bourke JP. Surface Atrial Frequency Analysis in Patients with Atrial Fibrillation:. A Tool For Evaluating the Effects of Intervention. J Cardiovasc Electrophysiol 2004; 15:1021-6. [PMID: 15363074 DOI: 10.1046/j.1540-8167.2004.04032.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The aims of this study were to evaluate (1) principal component analysis as a technique for extracting the atrial signal waveform from the standard 12-lead ECG and (2) its ability to distinguish changes in atrial fibrillation (AF) frequency parameters over time and in response to pharmacologic manipulation using drugs with different effects on atrial electrophysiology. METHODS AND RESULTS Twenty patients with persistent AF were studied. Continuous 12-lead Holter ECGs were recorded for 60 minutes, first, in the drug-free state. Mean and variability of atrial waveform frequency were measured using an automated computer technique. This extracted the atrial signal by principal component analysis and identified the main frequency component using Fourier analysis. Patients were then allotted sequentially to receive 1 of 4 drugs intravenously (amiodarone, flecainide, sotalol, or metoprolol), and changes induced in mean and variability of atrial waveform frequency measured. Mean and variability of atrial waveform frequency did not differ within patients between the two 30-minute sections of the drug-free state. As hypothesized, significant changes in mean and variability of atrial waveform frequency were detected after manipulation with amiodarone (mean: 5.77 vs 4.86 Hz; variability: 0.55 vs 0.31 Hz), flecainide (mean: 5.33 vs 4.72 Hz; variability: 0.71 vs 0.31 Hz), and sotalol (mean: 5.94 vs 4.90 Hz; variability: 0.73 vs 0.40 Hz) but not with metoprolol (mean: 5.41 vs 5.17 Hz; variability: 0.81 vs 0.82 Hz). CONCLUSION A technique for continuously analyzing atrial frequency characteristics of AF from the surface ECG has been developed and validated.
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Affiliation(s)
- Dan Raine
- Department of Academic Cardiology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom.
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Raine D, Dark J, Bourke JP. Effect of mitral valve repair/replacement surgery on atrial arrhythmia behavior. J Heart Valve Dis 2004; 13:615-21. [PMID: 15311868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
BACKGROUND AND AIMS OF THE STUDY Few data have been published on the effects of mitral valve surgery on atrial rhythm. The study aims were to determine the effects of surgery on: (i) persistence of atrial fibrillation (AF); (ii) measures of left atrial and ventricular dimensions; and (iii) ECG P-wave duration. METHODS A retrospective case-note review of 92 patients with chronic mitral regurgitation was undertaken. Variables determined included prevalence and duration of AF; incidence of new-onset or persistence of AF after surgery; rhythm changes in relation to age, gender, left atrial and ventricular dimensions and function, anti-arrhythmic drug usage and ECG P-wave duration in sinus rhythm prior to surgery. RESULTS Only 4/47 (8.5%) patients with any history of AF before surgery were in sinus rhythm at six months after surgery. All 28 patients with persistent AF for >12 months and 41/45 (91%) in sinus rhythm before surgery retained these rhythms after surgery. The left atrial dimension was decreased after surgery, in the whole group (51.3 +/- 9.0 versus 48.4 +/- 9.5 mm; p = 0.011) and in the subgroup in sinus rhythm, but not in the subgroup in AF. The left ventricular end-diastolic dimension decreased in the group as a whole (60.6 +/- 6.2 versus 53.0 +/- 8.7 mm; p = 0.0001) and in both subgroups after surgery. In 24 patients with 12- lead ECGs in sinus rhythm before and three months after surgery, P-wave duration remained unchanged. However, this measure decreased in the 18 patients in sinus rhythm consistently, but increased in the six patients continuing to have paroxysmal AF after surgery. CONCLUSION Mitral valve surgery alone restored sinus rhythm in only 8.5% of patients with any previous history of AF. Concomitant anti-arrhythmic procedures should be considered for all patients with AF who undergo mitral valve surgery.
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Affiliation(s)
- Dan Raine
- Department of Academic Cardiology, Freeman Hospital, Newcastle upon Tyne NHS Hospitals Trust, UK.
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Nelson HS, Branch LB, Raine D, Spaulding H, Black JW, Pfeutze B, Wood D. beta-Adrenergic subsensitivity induced by chronic administration of terbutaline. Int Arch Allergy Appl Immunol 1977; 55:362-73. [PMID: 591102 DOI: 10.1159/000231947] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The effect of 6-day courses of terbutaline and ephedrine on the metablic and hemodynamic responses to a 4-hour epinephrine infusion were compared in the same five individuals. Terbutaline suppressed the subsequent lactate response to epinephrine more than ephedrine did. The suppression of blood glucose response to epinephrine was similar for the two drugs. Ephedrine profoundly altered the hemodynamic responses to epinephrine causing significantly higher systolic and diastolic blood pressures and slower pulse. Terbutaline did not alter the systolic blood pressure during subsequent epinephrine infusion, and had less effect than ephedrine on the diastolic pressure and heart rate during the infusion. The effect of terbutaline on physiologic responses to exercise was studied, employing both brief strenuous and prolonged moderate treadmill exercice. Following 6 days of terbutaline the blood glucose and lactate levels during and following exercise were consistently but not markedly reduced. There was no effect on hemodynamic responses or on blood levels of free fatty acids, nor did exercise tolerance appear to be reduced. The 6-day course of terbutaline did not alter the bronchial sensitivity to inhaled methacholine as measured by spirometry. We conclude that subsensitivity is a characteristic response in most tissues to chronic exogenous adrenergic stimulation. The failure to demonstrate altered methacholine sensitivity may indicate that the adrenergic receptors of the bronchial smooth muscles are an exception to this rule, or, more likely, may reflect the difficulty in demonstrating partial bronchial adrenergic blockade in normal individuals.
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