Effect of epinephrine on the efficacy of the internal cardioverter-defibrillator
Open accessAbstract
To evaluate the effect of sympathetic activation on the efficacy of the implantable cardioverter-defibrillator (ICD) in converting ventricular tachycardia (VT) or ventricular fibrillation (VF), 32 patients who received an ICD because of life-threatening VT/VF underwent 1 week postimplant ICD testing both before and after infusion of 25 (16 patients) or 50 (16 patients) ng/kg/min of epinephrine for greater than or equal to 12 minutes. These infusion rates are known to result in plasma epinephrine concentrations comparable to mild-moderate stress. The patients' mean age was 63 +/- 10 years; 26 had coronary artery disease, 2 had dilated cardiomyopathy and 4 had no evidence of structural heart disease. VT and VF were induced in 16 patients each by programmed stimulation or alternating current. Among the 16 patients with VT, the first ICD discharge (26 to 30 J) was effective in 15 patients in the baseline state and in all 16 patients during epinephrine infusion. Among patients with VF, the first ICD discharge (26 to 30 J) terminated VF in all patients in the baseline state, compared with 12 of 16 patients during epinephrine infusion (p less than 0.05). In 4 patients, VF was terminated during epinephrine infusion only by the second or third ICD discharge (30 J). In conclusion, physiologic increases in the plasma epinephrine concentration may increase the number and energy of shocks needed to terminate VF.
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- Authors
- Sousa, J., Kou, W., Calkins, H., Rosenheck, S., Kadish, A., & Morady, F.
- Affiliations
- University of Michigan (US)
- Corresponding author
- Morady, Fred
- ORCID
- Kadish, Alan
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 1992-02
- Volume
- 69
- Issue
- 5
- Pages
- 509-512
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W1998484581
- Cited by
- 51
- References
- 14
- Citations by year
- 2023: 1 · 2022: 1 · 2020: 2 · 2019: 3 · 2018: 2 · 2017: 2 · 2015: 1 · 2014: 1 · 2013: 5 · 2012: 3
- FWCI
- 1.83
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- epinephrine, implantable cardioverter-defibrillator, ventricular tachycardia, ventricular fibrillation, sympathetic activation, programmed electrical stimulation, coronary artery disease, dilated cardiomyopathy
- MeSH terms
- Aged, Electric Countershock, Epinephrine, Female, Heart, Heart Rate, Humans, Infusions, Intravenous, Male, Middle Aged, Sympathetic Nervous System, Tachycardia, Ventricular Fibrillation, Prostheses and Implants
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