The Risk of Adverse Events Associated With Atropine Administration During Dobutamine Stress Echocardiography in Cardiac Transplant Patients: A 28-Year Single-Center Experience

Abstract

Background Although dobutamine stress echocardiography (DSE) is performed in heart transplant patients, the safety profile of atropine administration in DSE in this setting is unclear. Methods and Results We identified heart transplant patients who received atropine during DSE from January 1984 to August 2011 at our institution and compared them with a propensity-scored matched control group of heart transplant patients who underwent DSE without atropine. Adverse events were defined as significant arrhythmias (sinus arrest, Mobitz type II heart block, complete heart block, ventricular tachycardia, or ventricular fibrillation), hypotension requiring hospitalization, syncope or presyncope, myocardial infarction, and death. Forty-five heart transplant patients (median age 62 years, 82% male) received 0.2–1 mg atropine during DSE. Of these, 1 patient (2.2%) developed temporary complete heart block. No adverse events were identified in the control group of 154 patients who received dobutamine without atropine. Conclusions Our findings suggest that complete heart block can occur infrequently with the administration of atropine in heart transplant patients undergoing DSE. Therefore, patients should be appropriately monitored for these adverse events during and after DSE.

Paradoxical worsening of bradycardia following atropine administration

“…Clinical guidelines for bradyarrhythmias are largely consistent across the globe, with intravenous (IV) atropine recommended as a first-line therapy, escalating to IV adrenaline or isoprenaline and transcutaneous pacing where atropine is unsuccessful ( Kusumoto et al, 2019 ; Soar et al, 2015 ). Although paradoxical worsening of bradyarrhythmias has previously been described following atropine administration in cardiac transplant recipients ( Bernheim et al, 2004 ; Ji et al, 2013 ), only sporadic case reports detail worsening of bradyarrhythmias in patients without previous significant cardiac disease in the OOH setting. In this case report, we describe a case in the OOH setting of ventricular standstill following the administration of atropine to a patient with bradycardia and 2:1 heart block.…”

Mobitz Type II Second‐Degree Atrioventricular Block during Dobutamine Stress Echocardiography. True or False?

“…When used for stress echocardiography, it rarely causes transient second‐degree atrioventricular (AV) block (0.6–1.1%) . The development of transient complete AV block is even rarer . In this respect, Varga et al .…”