Myocardial and cerebral hemodynamics during tachyarrhythmia-induced hypotension in the rat.

Hagendorff, Andreas; Dettmers, C.; Dános, P.; Pizzulli, Luciano; Omran, Heyder; Manz, M; Hartmann, A.; Lüderitz, Berndt

doi:10.1161/01.cir.90.1.400

Cited by 16 publications

(10 citation statements)

References 39 publications

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“…Neuromonitoring during VT ablation is clinically relevant because (1) the optimal MAP necessary to maintain end-organ perfusion during hemodynamically significant VT is unknown, (2) cerebral desaturations (SctO2 values <50%-55%) seem to predict short-and long-term mortality and morbidity in patients undergoing cardiac surgery, and (3) CerOx monitoring can detect alterations in oxygenation earlier than other commonly used noninvasive methods. [17][18][19] Finally, in patients undergoing pLVAD-assisted VT ablation, during which there are frequently prolonged periods of nonpulsatile flow, the mean intravascular and cerebral perfusion pressures necessary to maintain organ and brain function may differ from conditions with pulsatile flow.…”

Section: Cerox Monitoring During Vt Ablationmentioning

confidence: 99%

Percutaneous Hemodynamic Support With Impella 2.5 During Scar-Related Ventricular Tachycardia Ablation (PERMIT 1)

Miller

Dukkipati

Chinitz

et al. 2013

Circ: Arrhythmia and Electrophysiology

103

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Background-Percutaneous left ventricular assist devices (pLVADs) are increasingly being used to facilitate ablation of unstable ventricular tachycardia (VT), but the safety profile and hemodynamic benefits of these devices have not been described in a systematic, prospective manner. Methods and Results-Twenty patients with scar VT underwent ablation with a pLVAD. Neuromonitoring using cerebral oximetry was performed to evaluate a cerebral desaturation threshold to guide the duration of activation/entrainment mapping. The efficacy of pLVAD support was tested in a controlled manner with simulated VT. Complete procedural success was achieved in 50% (n=8) of patients, who were initially inducible for sustained VT, and partial procedural success in 37% (n=6). Using a cerebral desaturation level of 55% as a lower safety limit to guide the duration of sustained VT, 3 patients (15%) developed mild acute kidney injury (all resolved), and 1 (5%) patient developed mild cognitive dysfunction. During fast simulated VT (300 ms), cerebral desaturation to ≤55% occurred in more than half (53%) of patients tested without pLVAD support, compared with only 5% with full pLVAD support (P=0.003). Conclusions-In a consecutive series of patients with severe left ventricular dysfunction, pLVAD-supported scar VT ablation was safe and feasible. During fast simulated VT, a miniaturized axial flow pump imparted a more favorable hemodynamic profile compared with pharmacological agents alone. Cerebral oximetry is a complimentary monitoring modality during scar VT ablation, and avoidance of cerebral desaturations below a threshold of 55% may safely guide the duration of mapping during unstable VT. (Circ Arrhythm Electrophysiol. 2013;6:151-159.)

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Section: Cerox Monitoring During Vt Ablationmentioning

confidence: 99%

Percutaneous Hemodynamic Support With Impella 2.5 During Scar-Related Ventricular Tachycardia Ablation (PERMIT 1)

Miller

Dukkipati

Chinitz

et al. 2013

Circ: Arrhythmia and Electrophysiology

103

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“…Whereas left ventricular function is normal in this animal model, left ventricular dysfunction is present in most of the patients with ventricular arrhythmias. Myocardial function, however, is markedly impaired, with decreasing cycle length of tachycardia [15]. No significant change in cerebral metabolic demand is found during deep barbital anesthesia [27].…”

Section: Discussionmentioning

confidence: 99%

“…Using a fixed pacing rate the decline in blood pressure is easily to regulate. This model appears to be very suitable for investigating short-term episodes of acute hypotension induced by rapid pacing [9,15,16]. It imitates the pathophysiological conditions after the sudden onset of hypotensive ventricular arrhythmias, which can often be observed in patients.…”

Section: Discussionmentioning

confidence: 99%

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Carotid artery stenosis and tachyarrhythmias: regional cerebral blood flow during high-rate ventricular pacing after one vessel occlusion in rats

et al. 1994

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The aim of the present study was to investigate the effect of hypotensive tachycardias on cerebral blood flow (CBF) in the presence of significant carotid stenosis. The experiments were performed in 57 spontaneously breathing rats during arterial normoxia and normocapnia anesthetized with thiobarbital. CBF was determined with radiolabeled microspheres during control conditions (normofrequent sinus rhythm, normotension; group A; n = 15), during high-rate left ventricular pacing (660-840 ppm) at normotension (group B1; n = 13), borderline hypotension (group B2; n = 15) and severe hypotension (group B3; n = 7). In addition, CBF measurements were performed during borderline hypotension induced by hemorrhage (group C; n = 7). Global CBF was 1.09 +/- 0.29 ml g-1 min-1 in group A, 0.93 +/- 0.40 in group B1, 0.68 +/- 0.31 in group B2 (P < 0.05 vs. A), 0.42 +/- 0.16 in group B3 (P < 0.05 vs. A) and 0.83 +/- 0.2 in group C. The highest CBF values were found in the cerebellum (A; 1.43 +/- 0.5 ml g-1 min-1) and the lowest in the postocclusive tissue of the ipsilateral hemisphere (A; 0.74 +/- 0.2 ml g-1 min-1). In all groups a 15% mean CBF reduction in the right hemispherical cerebrum in comparison to the left hemisphere was observed (P < 0.01). In contrast, hemispherical CBF of the cerebellum did not differ. The CBF blood pressure relationship shifted to lower CBF values, the threshold of CBF regulation shifted to higher blood pressure values in the tissue regions distal to the occluded vessel during hypotensive tachycardias.(ABSTRACT TRUNCATED AT 250 WORDS)

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“…Bei diesen Patienten kann also hypothetisch eine Einschränkung mentaler und kognitiver Funktionen infolge chronischer Perfusionsminderungen postuliert werden (17). Dafür spricht, dass in experimentellen Untersuchungen Ischämie-reaktionen speziell im Hippocampusgebiet bei Arrhythmien dokumentiert wurden (3, 9,11,14). Es ist somit zu diskutieren, ob bei speziellen Patienten die Diagnostik einer zerebrovaskulären Regulationsstörung nicht zum Bestandteil einer interdisziplinä-ren kardiologischen, neurologischen und angiologischen Patientenbetreuung werden sollte (siehe Abb.…”

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Wird die Hirndurchblutung durch Veränderungen des Herzzeitvolumens beeinträchtigt? Messungen der Hirndurchblutung an Normalpersonen während Volumenbelastung und an Herzschrittmacher- Patienten bei Veränderungen der Stimulationsfrequenz

Hagendorff¹,

Kölsch

Dettmers

et al. 2001

Z Kardiol

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A constant cerebral blood flow (CBF) in the presence of systemic blood pressure changes and cardiac output (CO) alterations during physiological conditions are postulated by the mechanism of cerebral autoregulation. The aim of the present study is the analysis of CBF in pacemaker (PM) patients with unspecific neurological symptoms. CBF was measured in 9 controls and 23 pacemaker patients with 133xenon, CO using Doppler echocardiography or impedance cardiography. Mean and individual CBF in controls remained unchanged when a CO increase of 28% induced by volume overload was observed. In PM patients a mean CO increase of 38% induced by an increase of basic pacing rate caused different effects of CBF. CBF increased or decreased by about 10% or remained constant. In summary, the data suggest an impairment of cerebrovascular function in those patients with concomittant CBF changes due to CO alterations (15/23 approximately equal to 65%). Thus, the analysis of brain perfusion in PM patients with unspecific neurological symptoms is possibly a new diagnostic feature in the future. It can be discussed whether or not indication and optimizing of pacemaker therapy has to be additionally analyzed by determination of endorgan perfusion.

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Myocardial and cerebral hemodynamics during tachyarrhythmia-induced hypotension in the rat.

Abstract: The proposed hypotension model is suitable to analyze tachyarrhythmia-induced hemodynamic changes and end-organ perfusion in the presence of myocardial dysfunction. It has the potential to test therapeutic strategies in the treatment of tachycardias.

Cited by 16 publications

References 39 publications

Percutaneous Hemodynamic Support With Impella 2.5 During Scar-Related Ventricular Tachycardia Ablation (PERMIT 1)

Percutaneous Hemodynamic Support With Impella 2.5 During Scar-Related Ventricular Tachycardia Ablation (PERMIT 1)

Carotid artery stenosis and tachyarrhythmias: regional cerebral blood flow during high-rate ventricular pacing after one vessel occlusion in rats

Wird die Hirndurchblutung durch Veränderungen des Herzzeitvolumens beeinträchtigt? Messungen der Hirndurchblutung an Normalpersonen während Volumenbelastung und an Herzschrittmacher- Patienten bei Veränderungen der Stimulationsfrequenz

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