Lehmann K G, Chen Y C
Section of Cardiology, Long Beach Veterans Administration Medical Center, Irvine, California 90822.
Am J Cardiol. 1989 Feb 15;63(7):447-51. doi: 10.1016/0002-9149(89)90317-2.
Sustained ventricular arrhythmia is a well-recognized complication of cardiac catheterization, often occurring after selective coronary artery injection of contrast medium. The role of autonomic reflexes in the pathogenesis of this phenomenon is unclear. Although the muscarinic antagonist atropine is often administered prophylactically before coronary angiography to reduce the likelihood of sinus bradycardia and vasovagal reactions, its influence on ventricular arrhythmias in this setting has not been established. This case-control trial studied 648 patients undergoing coronary arteriography to investigate this issue. Eleven case subjects (those with ventricular tachyarrhythmia) were identified. Control subjects (those without ventricular tachyarrhythmia) were matched for baseline heart rate (+/- 6 beats/min), age (+/- 10 years), sex and calendar year of procedure using a 1:3 sampling ratio. All 26 potential clinical, anatomic and hemodynamic covariates were statistically similar between groups. Ventricular tachyarrhythmias were more likely to occur after selective right coronary injection (odds ratio 15.1, p = 0.0008) but not after multiple contrast injections (odds ratio 0.918, difference not significant). Most importantly, atropine sulfate was administered prophylactically to 18 of 33 control subjects (55 +/- 9%) but only 1 of 11 cases (9 +/- 9%), generating a significant odds ratio of 12.0 (p = 0.02). Thus, the odds of experiencing sustained ventricular tachyarrhythmias during coronary arteriography may potentially be reduced 12-fold by prior administration of atropine, even in patients with normal baseline heart rates.
持续性室性心律失常是心脏导管插入术一种公认的并发症，常在选择性冠状动脉注射造影剂后发生。自主神经反射在这一现象发病机制中的作用尚不清楚。尽管在冠状动脉造影前常预防性使用毒蕈碱拮抗剂阿托品以降低窦性心动过缓和血管迷走反应的可能性，但其在此种情况下对室性心律失常的影响尚未明确。这项病例对照试验研究了648例接受冠状动脉造影的患者以调查这一问题。确定了11例病例受试者（即发生室性快速性心律失常者）。对照受试者（即无室性快速性心律失常者）按照1:3的抽样比例根据基线心率（±6次/分钟）、年龄（±10岁）、性别和手术年份进行匹配。两组之间所有26项潜在的临床、解剖和血流动力学协变量在统计学上均相似。室性快速性心律失常更可能发生在选择性右冠状动脉注射后（优势比15.1，p = 0.0008），但在多次注射造影剂后则不然（优势比0.918，差异无统计学意义）。最重要的是，33例对照受试者中有18例（55±9%）预防性使用了硫酸阿托品，而11例病例受试者中只有1例（9±9%），产生了显著的优势比12.0（p = 0.02）。因此，即使是基线心率正常的患者，冠状动脉造影期间发生持续性室性快速性心律失常的几率也可能因预先使用阿托品而降低12倍。
