Cardiac Arrhythmia, Supraventricular Arrhythmia
Conditions
Keywords
Electrophysiological study, Atropine, Isoprenaline, Supraventricular arrhythmia, Ablation
Brief summary
During electrophysiological study (EPS) multiple drugs are used to reveal arrhythmias and/or conductive system disorders. Two most often used agents are atropine and isoprenaline. Due to their distinct pharmacological properties, they are affecting myocardium in different manner. Those dissimilarities can affect the EPS course and long-term prognosis. The aim of presented study is to evaluate the optimal protocol of pharmacotherapy during EPS.
Detailed description
Electrophysiological study (EPS) is essential tool for heart rhythm disorders diagnostic. Inducibility of arrhythmia before ablation to confirm the diagnosis and inability to do so after the procedure is crucial for long-term success. Multiple drugs are used to reveal arrhythmias and/or conductive system disorders. Two most often used are atropine and isoprenaline. Atropine is a natural, selective antagonist of cholinergic receptors M1 and M2. It reverses the inhibitory effect of vagal nerve on myocardium. This improves sinus node automatism and conduction in atrioventricular node. Isoprenaline is a preferential agonist of beta-1-adrenergic receptors. It has bathmotropic and chronotropic effect. During daily clinical practice those two drugs are often used interchangeably. However, differences in pharmacokinetics and pharmacodynamics may affect the results. There are lack of data directly comparing those two agents. There are isolated evidences that arrhythmia inducibility rate after the ablation differs between those two drugs. This may lead to the misconception of ablation as successful. The aim of presented study is to evaluate the optimal protocol of pharmacotherapy during EPS.
Interventions
DRUGComparison of atropine and isoprenaline
Comparison of heart conductive system and arrhythmia inducibility after using atropine or isoprenaline
Sponsors
Medical University of Lodz
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients with indication for electrophysiological study according to present guidelines of European Society of Cardiology
Exclusion criteria
* Not willing or incapable to give written informed consent. * Previous diagnosed ventricle tachycardia or fibrillation * Previous diagnosed atrial fibrillation or flutter * Glaucoma (contraindication for atropine)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Long-term success rate | 12 months | Recurrence of clinical arrhythmia during 12 months of observation |
| Evaluation of sinus node recovery time | During the procedure | Sinus node recovery time (ms) during programed atrial stimulation will be assessed to examine the function of sinus node. |
| Evaluation of anterograde atrioventricular conduction | During the procedure | Anterograde Wenkebach point (ms) and effective refractory period of atrioventricular node (ms) during programed atrial stimulation will be assessed. |
| Evaluation of retrograde atrioventricular conduction | During the procedure | Retrograde Wenkebach point (ms) and effective refractory period of atrioventricular node (ms) during programed ventricular stimulation will be assessed. |
| Arrhythmia inducibility | During the procedure | Inducibility of anticipated arrythmia before and after drug administration and after eventual ablation. |
| Evaluation of sino-atrial conduction time | During the procedure | Sino-atrial conduction time (ms) during programed atrial stimulation will be assessed to examine the function of sinus node. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of adverse events during the 12-month follow up. | 12 months | Analysis of adverse events during the 12-month follow up according to used drug. Adverse events includes: death, stroke, cardiogenic shock, anaphylaxis, myocardial infarction, electric storm. |
| Length of the procedure | During the procedure | Analysis of the whole procedure time according to used drug. |
| Procedure time form drug administration till the end. | During the procedure | Analysis of the procedure time form atropine/isoprenaline administration till the end. |
| Incidence of adverse events during the electrophysiological study. | During the procedure | Analysis of adverse events during the electrophysiological study according to used drug. Adverse events includes: death, stroke, cardiogenic shock, anaphylaxis, myocardial infarction, electric storm. |
Countries
Poland
Contacts
Primary ContactKrzysztof Kaczmarek, MD, PhD
Outcome results
None listed