Ventricular Fibrillation and Tachycardia after Intravenous Atropine for Treatment of Bradycardias

Massumi, Rashid A.; Mason, Dean T.; Amsterdam, Ezra A.; DeMaria, Anthony N.; Miller, Richard R.; Scheinman, Melvin M.; Zelis, Robert

doi:10.1056/nejm197208172870706

Cited by 110 publications

(16 citation statements)

References 16 publications

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“…Rarely, ventricular tachycardia and fibrillation occur after the intravenous administration of atropine. 33 Pacemaker insertion is the treatment of choice for symptomatic bradycardia not responding promptly to atropine administration (see elsewhere). Recommendations …”

Section: Side Effectsmentioning

confidence: 99%

ACC/AHA guidelines for the early management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (subcommittee to develop guidelines for the early management of patients with acute myocardial infarction).

Gunnar¹,

Bourdillon²,

Dixon³

et al. 1990

Circulation

306

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PreambleIt is becoming more apparent each day that despite a strong national commitment to excellence in health care, the resources and personnel are finite. It is, therefore, appropriate that the medical profession examine the impact of developing technology on the practice and cost of medical care. Such analysis, carefully conducted, could potentially have an impact on the cost of medical care without diminishing the effectiveness of that care.

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Section: Side Effectsmentioning

confidence: 99%

ACC/AHA guidelines for the early management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (subcommittee to develop guidelines for the early management of patients with acute myocardial infarction).

Gunnar¹,

Bourdillon²,

Dixon³

et al. 1990

Circulation

306

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“…5 Recent attention has been directed toward the electrophysiologic effects of the parasympathetic nervous system.9 Reduced vagal-cardiac activity, as reflected by diminished respiration-related variations in heart rate (respiratory sinus arrhythmia), is associated with an increased incidence of sudden death,'1'3 and parasympathetic blockade has been shown to precipitate ventricular arrhythmias, including ventricular fibrillation. 14 In contrast, augmentation of vagal-cardiac activity provoked by injections of pressor drugs or carotid sinus massage may terminate ventricular tachycardia in man. 15 16 The possibility that vagal-cardiac nervous activity could be augmented over the long term in man has not been tested.…”

mentioning

confidence: 99%

The long-term increase of baseline and reflexly augmented levels of human vagal-cardiac nervous activity induced by scopolamine.

Dibner-Dunlap¹,

Eckberg²,

Magid³

et al. 1985

Circulation

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We tested the hypothesis that transdermal scopolamine increases vagal-cardiac nervous outflow over the long term in 16 healthy young men. Twenty-four hours after application of one scopolamine patch, the average RR interval was increased by 13% and the average standard deviation of the RR interval (taken as an index of the level of vagal-cardiac nervous activity) was increased by 31 %. Baroreceptor-cardiac reflex responsiveness (as reflected by prolongation of RR interval provoked by graded neck suction) also was increased substantially. These findings suggest that vagal-cardiac nervous activity can be augmented pharmacologically in man on a long-term basis. Since vagal outflow influences cardiac electrical properties in an important way, these findings may have therapeutic implications. Circulation 71, No. 4, 797-804, 1985. A LARGE BODY of basic and clinical research suggests that levels of autonomic nervous system activity contribute to the occurrence of ventricular arrhythmias and sudden cardiac death.") The harmful effects of increased sympathetic activity have been well documented,4 and the beneficial effects of sympathetic blockade in reducing mortality in high-risk patients have been recognized.5Recent attention has been directed toward the electrophysiologic effects of the parasympathetic nervous system.9 Reduced vagal-cardiac activity, as reflected by diminished respiration-related variations in heart rate (respiratory sinus arrhythmia), is associated with an increased incidence of sudden death,'1'3 and parasympathetic blockade has been shown to precipitate ventricular arrhythmias, including ventricular fibrillation. 14 In contrast, augmentation of vagal-cardiac Supported by grants from the NIH (HL22296), the Veterans Administration, and CIBA Consumer Pharmaceuticals, Edison, NJ.Address

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“…Massumi et al have recently reported the occurrence of ventricular fibrillation and tachyeardia following its use. 62 During anaesthesia, bradyeardia from vagal activity is sufficiently prevented by the judicious use of gallamine as to make further correction rarely indicated. Paneuronium appears to be equally promising in this respect.…”

Section: Maintenancementioning

confidence: 99%

Patients with cardiac valve prosthesis: Subsequent anaesthetic management for non-cardiac surgical procedures

Maillé

Dyrda

Paiement

et al. 1973

Canad. Anaesth. Soc. J.

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IN aECENT YEARS, cardiac surgery has created a new category of patients: individuals with prosthetic heart valves. The number of these patients is growing rapidly, and many will require the services of anaesthetists either for surgery or intensive care. This study will review the clinical problems associated with prosthetic valves, and the anaesthetic management of such patients.The clinical problems in patients with a single prosthesis are fewer but not different from those seen in patients with multiple valves. 1 For this reason, we will consider all patients with artificial valves as a homogeneous group. Points of interest to anaesthetists will be stressed. Survival rateRecent figures indicate a long-term (more than two years) survival rate of 70 to 75 per cent. 2-~ Our own ten-year experience with more than 1,000 cases corroborates these figures. Clinical condition of surviving patientsOur study disclosed a subjective improvement in 89 per cent of surviving patients. 6,7 Most of them lead a near-normal life. The measurement of improvement was based on the New York Heart Association Classification.In 34 per cent of the cases, considered as good results, the functional incapacity decreased by two grades. In another 55 per cent, considered as satisfactory results, the functional incapacity decreased by one grade. The remaining 11 per cent showed no change in their incapacity. The functional improvement to be expected is usually maximal after two years.Radiologieal signs of cardiomegaly and pulmonary hypertension fade away progressively over a period of two to five years. 8 The electrocardiographic signs of left ventricular hypertrophy and strain usually regress over the years but rarely disappear completely2 -° Most patients can resume a mild degree of physical activity three months postoperatively. 1° Fifty-five per cent tolerate a level of activity that can be considered as normal, six months after surgery. TM However, even in cases considered as improved by surgery, some degree of

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Ventricular Fibrillation and Tachycardia after Intravenous Atropine for Treatment of Bradycardias

Cited by 110 publications

References 16 publications

The long-term increase of baseline and reflexly augmented levels of human vagal-cardiac nervous activity induced by scopolamine.

Patients with cardiac valve prosthesis: Subsequent anaesthetic management for non-cardiac surgical procedures

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