Atropine vs Isoprenaline in the Invasive Diagnosis of Arrhythmias
Study Details
Study Description
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.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
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.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Active Comparator: Atropine Patients in whom during electrophysiological study atropine will be used. I.v. bolus of 0.01 mg/kg b.w. will be administered to reach the increase of heart rate of 25% or up to 130/min. If necessary, dose will be increased every 5 minutes until mention above parameters are achieved. Maximum dose will be 0.4 mg/kg b.w. |
Drug: Comparison of atropine and isoprenaline
Comparison of heart conductive system and arrhythmia inducibility after using atropine or isoprenaline
|
| Active Comparator: Isoprenaline Patients in whom during electrophysiological study isoprenaline will be used. Continuous i.v. infusion of 0.01 mcg/kg b.w./min will be administered to reach the increase of heart rate of 25% or up to 130/min. If necessary, dose will be doubled every 5 minutes until mention above parameters are achieved. Maximum dose will be 20 mcg/min. |
Drug: Comparison of atropine and isoprenaline
Comparison of heart conductive system and arrhythmia inducibility after using atropine or isoprenaline
|
Outcome Measures
Primary Outcome Measures
- 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.
- 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.
- Long-term success rate [12 months]
Recurrence of clinical arrhythmia during 12 months of observation
Secondary Outcome Measures
- 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.
- 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.
Eligibility Criteria
Criteria
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
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Previous diagnosed atrial fibrillation or flutter
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Glaucoma (contraindication for atropine)
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Department of Electrocardiology Medical University of Lodz | Lodz | Poland | 93-216 |
Sponsors and Collaborators
- Medical University of Lodz
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- RNN/327/20/KE