Title: Effect of early administration of atropine on paradoxic sinus deceleration during dobutamine stress echocardiography
Abstract: Dobutamine stress echocardiography (DSE) is a well-established, safe, and reliable technique for diagnosis of coronary artery disease. 1 Sawada S.G. Segar D.S. Ryan T. Brown S.E. Dohan A.M. Williams R. Fineberg N.S. Armstrong W.F. Feigenbaum H. Echocardiographic detection of coronary artery disease during dobutamine infusion. Circulation. 1991; 83: 1605-1614 Crossref PubMed Scopus (653) Google Scholar The generally accepted protocol for DSE involves infusion of increasing doses of dobutamine from 5 to 40 μg/kg/min at 3-minute intervals. 2 Cohen J.L. Greene T.O. Binenbaum S.Z. Wilchfort S.D. Kim C.S. Alston J.R. Dobutamine digital echocardiography for detecting coronary artery disease. Am J Cardiol. 1991; 67: 1311-1318 Abstract Full Text PDF PubMed Scopus (209) Google Scholar In about 1/3 of patients, however, target heart rate cannot be achieved by the administration of dobutamine alone. Failure to achieve an adequate heart rate during DSE is attributed to the use of β-adrenergic blocking agents, 3 Fioretti P.M. Poldermans D. Salustri A. Forster T. Bellotti P. Boersma B. McNeill A.J. El-Said E.S.M. Roelandt J.R. Atropine increases the accuracy of dobutamine stress echocardiography in patients taking beta-blockers. Eur Heart J. 1994; 15: 355-360 Crossref PubMed Google Scholar chronotropic incompetence, 4 Elhendy A. Van Domburg R.T. Bax J.J. Nierop P.R. Geleijnse M.L. Ibrahim M.M. Roelandt J.R.T.C. The functional significance of chronotropic incompetence during dobutamine stress test. Heart. 1999; 81: 398-403 PubMed Google Scholar , 5 McNeill A.J. Fioretti P.M. El-Said E.S.M. Salustri A. Forster T. Roelandt J.R. Enhanced sensitivity for detection of coronary artery disease by addition of atropine to dobutamine stress echocardiography. Am J Cardiol. 1992; 70: 41-46 Abstract Full Text PDF PubMed Scopus (353) Google Scholar or paradoxic sinus deceleration (PSD). 6 Mazeika P.K. Nadazdin A. Oakley C.M. Clinical significance of abrupt vasodepression during dobutamine stress echocardiography. Am J Cardiol. 1992; 69: 1484-1486 Abstract Full Text PDF PubMed Scopus (49) Google Scholar , 7 Hopfenspirger M.R. Miller T.D. Christian T.F. Gibbons R.J. Sinus node deceleration during dobutamine perfusion scintigraphy as a marker of inferior ischemia. Am J Cardiol. 1994; 74: 817-819 Abstract Full Text PDF PubMed Scopus (17) Google Scholar , 8 Attenhofer C.H. Pellikka P.A. McCully R.B. Roger V.L. Seward J.B. Paradoxical sinus deceleration during dobutamine stress echocardiography description and angiographic correlation. J Am Coll Cardiol. 1997; 29: 994-999 Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar , 9 Emre A. Ersek B. Gursurer M. Aksoy M. Myocardial perfusion and angiographic findings in patients with paradoxical sinus deceleration during dobutamine technetium-99m sestamibi-gated SPECT imaging. Cardiology. 1999; 92: 183-188 Crossref PubMed Scopus (5) Google Scholar PSD is characterized by an initial increase followed by a significant decrease in heart rate during incremental doses of dobutamine. 6 Mazeika P.K. Nadazdin A. Oakley C.M. Clinical significance of abrupt vasodepression during dobutamine stress echocardiography. Am J Cardiol. 1992; 69: 1484-1486 Abstract Full Text PDF PubMed Scopus (49) Google Scholar , 7 Hopfenspirger M.R. Miller T.D. Christian T.F. Gibbons R.J. Sinus node deceleration during dobutamine perfusion scintigraphy as a marker of inferior ischemia. Am J Cardiol. 1994; 74: 817-819 Abstract Full Text PDF PubMed Scopus (17) Google Scholar , 8 Attenhofer C.H. Pellikka P.A. McCully R.B. Roger V.L. Seward J.B. Paradoxical sinus deceleration during dobutamine stress echocardiography description and angiographic correlation. J Am Coll Cardiol. 1997; 29: 994-999 Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar , 9 Emre A. Ersek B. Gursurer M. Aksoy M. Myocardial perfusion and angiographic findings in patients with paradoxical sinus deceleration during dobutamine technetium-99m sestamibi-gated SPECT imaging. Cardiology. 1999; 92: 183-188 Crossref PubMed Scopus (5) Google Scholar This is believed to result from activation of the cardioinhibitory reflex (Bezold-Jarisch reflex) through left ventricular sensory receptors. 7 Hopfenspirger M.R. Miller T.D. Christian T.F. Gibbons R.J. Sinus node deceleration during dobutamine perfusion scintigraphy as a marker of inferior ischemia. Am J Cardiol. 1994; 74: 817-819 Abstract Full Text PDF PubMed Scopus (17) Google Scholar , 8 Attenhofer C.H. Pellikka P.A. McCully R.B. Roger V.L. Seward J.B. Paradoxical sinus deceleration during dobutamine stress echocardiography description and angiographic correlation. J Am Coll Cardiol. 1997; 29: 994-999 Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar Although suggested by some, 7 Hopfenspirger M.R. Miller T.D. Christian T.F. Gibbons R.J. Sinus node deceleration during dobutamine perfusion scintigraphy as a marker of inferior ischemia. Am J Cardiol. 1994; 74: 817-819 Abstract Full Text PDF PubMed Scopus (17) Google Scholar , 9 Emre A. Ersek B. Gursurer M. Aksoy M. Myocardial perfusion and angiographic findings in patients with paradoxical sinus deceleration during dobutamine technetium-99m sestamibi-gated SPECT imaging. Cardiology. 1999; 92: 183-188 Crossref PubMed Scopus (5) Google Scholar it is unclear whether left ventricular inferoposterior wall ischemia is the trigger for PSD. In the present study, we sought to identify the characteristics of patients with PSD during DSE and to determine whether early administration of atropine could prevent its development.
Publication Year: 2002
Publication Date: 2002-03-01
Language: en
Type: article
Indexed In: ['crossref', 'pubmed']
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Cited By Count: 10
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