Dataset Information

Prophylactic Intravenous Aminophylline for Preventing Bradyarrhythmias During Coronary Atherectomy: A 10-Year Single-Center Experience.

ABSTRACT:

Background

Aminophylline, an adenosine antagonist, can be used to prevent adenosine-mediated bradyarrhythmias.

Methods

Retrospective, observational, descriptive analysis of patients undergoing rotational atherectomy with intravenous (IV) aminophylline pretreatment during a 10-year period (2010-2020). The primary composite outcome was the occurrence of a documented bradyarrhythmia requiring pharmacologic intervention and/or temporary pacemaker (TPM) implantation.

Results

A total of 296 patients received IV aminophylline pretreatment. The primary composite outcome occurred in 1.7% (n = 5) of patients. None of the patients required rescue TPM. Bradyarrhythmias were documented in 2.4% (n = 7) of patients. Pharmacologic interventions, typically with IV atropine, were used in 15% (n = 43) of patients. Per-vessel analyses demonstrated that patients undergoing atherectomy to the circumflex and right coronary arteries were more likely than those undergoing atherectomy to other vessels to have bradyarrhythmias requiring pharmacologic intervention (3.4% vs 0%, P = .01).

Conclusions

In this 10-year single-center experience using IV aminophylline pretreatment to prevent major bradyarrhythmias in patients undergoing coronary atherectomy, none of the patients required rescue TPM implantation. These data demonstrate that coronary atherectomy can be performed safely without prophylactic TPM, with aminophylline pretreatment and selective use of atropine representing an effective noninvasive approach.

SUBMITTER: Knott JD

PROVIDER: S-EPMC11308821 | biostudies-literature | 2023 May-Jun

REPOSITORIES: biostudies-literature

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Publications

Prophylactic Intravenous Aminophylline for Preventing Bradyarrhythmias During Coronary Atherectomy: A 10-Year Single-Center Experience.

Knott Jonathan D JD Sabbah Michael S MS Lewis Bradley R BR Hassan Abdalla A Gladden James D JD Bell Malcolm R MR Holmes David R DR Brinkman Nathan N Konz Brent B Singh Mandeep M Rihal Charanjit S CS Barsness Gregory W GW Prasad Abhiram A Sandhu Gurpreet S GS Gulati Rajiv R Sandoval Yader Y

Journal of the Society for Cardiovascular Angiography & Interventions 20230202 3

<h4>Background</h4>Aminophylline, an adenosine antagonist, can be used to prevent adenosine-mediated bradyarrhythmias.<h4>Methods</h4>Retrospective, observational, descriptive analysis of patients undergoing rotational atherectomy with intravenous (IV) aminophylline pretreatment during a 10-year period (2010-2020). The primary composite outcome was the occurrence of a documented bradyarrhythmia requiring pharmacologic intervention and/or temporary pacemaker (TPM) implantation.<h4>Results</h4>A t ...[more]

PMID: 39130697

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Project description:BackgroundOrbital atherectomy (OA) is a known alternative to other atherectomy devices. However, some complex patient demographics (eg, left ventricular ejection fraction <25%) were excluded from the first-in-human trial (ORBIT I) and the pivotal FDA device approval trial (ORBIT II) which evaluated the safety and efficacy of OA in severely calcified de novo coronary lesions. This single-operator cohort study aimed to examine the impact of OA on a real-world complex Veterans Affairs patient subset.MethodsRetrospective analysis was completed on 40 consecutive patients with severely calcified coronary lesions who underwent OA prior to drug-eluting stent placement at the Atlanta Veterans Affairs Medical Center from January 2015 to June 2017.ResultsOrbital atherectomy plus drug-eluting stent placement was successful in all 40 cases. Chocolate focal force balloon angioplasty was the most commonly used post-atherectomy balloon (N = 34, 85%). Few complications were observed, including one case (2.5%) of perforation and one case (2.5%) of no-reflow. Neither acute stent thrombosis nor emergent coronary artery bypass grafting was observed. The intravascular ultrasound (IVUS)-determined median [IQR] pre-procedure minimum lumen area and post-procedure minimum stent area (MSA) were 2.8 [2.2, 3.0] mm2 and 8.7 [7.7, 10.0] mm2, respectively (P < 0.0001, Mann-Whitney test). Major adverse cardiovascular events, including all-cause mortality, at 30 days and at a median [IQR] follow-up of 197.5 [35.5, 461.3] days, was 5% and 10%, respectively. During that period, one target vessel revascularization (2.5%) was observed.ConclusionsThis study indicates that OA is a useful tool in performing high-risk percutaneous coronary intervention effectively in VA patients with severely calcified coronary lesions. OA plaque modification in combination with a high utilization rate of IVUS and Chocolate focal force angioplasty facilitates stent delivery and optimal stent expansion, resulting in a large MSA.

Dataset Information

Prophylactic Intravenous Aminophylline for Preventing Bradyarrhythmias During Coronary Atherectomy: A 10-Year Single-Center Experience.

Background

Methods

Results

Conclusions

Publications

Prophylactic Intravenous Aminophylline for Preventing Bradyarrhythmias During Coronary Atherectomy: A 10-Year Single-Center Experience.

Similar Datasets

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