Paradoxical reflex bradycardia after epinephrine infusion for arrhythmia induction in the electrophysiology laboratory

Larsen, Timothy R.; Kaszala, Károly; Tan, Alex Y.; Ellenbogen, Kenneth A.; Huízar, José F.

doi:10.1016/j.hrcr.2018.07.004

Cited by 8 publications

(9 citation statements)

References 7 publications

(9 reference statements)

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“…In the present study, none of the patients who were injected with ISP and EPI had any drug‐related complications. In previous reports describing EPI injections for inducing paroxysmal supraventricular tachycardia, the dosage of EPI for supraventricular tachycardia induction was 0.2‐0.4 µg/kg/min, which was lower than the dosage of the induction protocol in our study 8,9 . In those reports, the EPI injection was not associated with significant complications.…”

Section: Discussioncontrasting

confidence: 58%

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Stepwise approach to induce infrequent premature ventricular complex using bolus isoproterenol and epinephrine infusion

Shinoda

Komatsu

Nogami

et al. 2020

Pacing Clinical Electrophis

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Background: Paucity of a premature ventricular complex (PVC) during ablation procedures may occur and be associated with a lower success rate. Isoproterenol (ISP) injections are commonly used to induce PVC; however, the induced tachycardia sometimes prevents the appearance of PVC. Epinephrine (EPI) administration may be an alternative strategy to induce PVC due to its smaller effect on heart rate (HR). This study sought to examine the electrophysiological impact of EPI injection, with a stepwise induction protocol, for infrequent intraprocedural PVC. Methods:We studied 78 consecutive patients who underwent catheter ablation of idiopathic frequent PVC. If no PVC was observed at the beginning of the procedure, ISP (10 µg) was injected. If clinical PVC was not induced by ISP administration, EPI (10 µg) was injected.Results: Of 18 patients without PVC at baseline, ISP injection induced PVC in five patients. Of the remaining 13 patients, EPI injection successfully induced PVC in seven patients (53%). The maximum HR and increments of HR after EPI injection were significantly lower than those after ISP injection (99 ± 15 vs 137 ± 15 bpm, P = .001; 22 ± 10 vs 53 ± 12 bpm, P < .001, respectively).There were no complications related to the induction protocol.Conclusion: EPI injection following ISP injection is an effective and safe stepwise approach for the induction of infrequent PVC in the electrophysiology laboratory. It is hypothesized that -andadrenergic receptor stimulation by EPI injections, with reduced HR acceleration compared to that with ISP injections, may result in the successful induction of PVC.

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Section: Discussioncontrasting

confidence: 58%

“…However, the induced tachycardia after ISP administration sometimes prevents the appearance of PVC. Injection of epinephrine (EPI) may be an alternative strategy to induce PVC during electrophysiological studies 8,9 . However, limited data exist regarding its efficacy and safety in inducing PVC.…”

Section: Introductionmentioning

confidence: 99%

Stepwise approach to induce infrequent premature ventricular complex using bolus isoproterenol and epinephrine infusion

Shinoda

Komatsu

Nogami

et al. 2020

Pacing Clinical Electrophis

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“…βAR stimulation by isoproterenol is associated with elevated heart rate, lability in T‐wave morphology and QT prolongation. While heart rate increases in a steady dose‐dependent manner after isoproterenol infusion, an early rise in heart rate is observed due to dual agonism of αARs and βARs via epinephrine without further progress at higher doses 103 or even reflex bradycardia and atrioventricular (AV) node block 112 …”

Section: Myocardial Catecholamine Signalling During the Acute Phase O...mentioning

confidence: 99%

Pathophysiology of Takotsubo syndrome – a joint scientific statement from the Heart Failure Association Takotsubo Syndrome Study Group and Myocardial Function Working Group of the European Society of Cardiology – Part 1: overview and the central role for catecholamines and sympathetic nervous system

Ömerovic

Citro

Bossone

et al. 2022

European J of Heart Fail

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This is the first part of a scientific statement from the Heart Failure Association (HFA) of the European Society of Cardiology focused upon the pathophysiology of Takotsubo syndrome and is complimentary to the previous HFA position statement on Takotsubo syndrome which focused upon clinical management. In part 1 we provide an overview of the pathophysiology of Takotsubo syndrome and fundamental questions to consider. We then review and discuss the central role of catecholamines and the sympathetic nervous system in the pathophysiology, and the direct effects of high surges in catecholamines upon myocardial biology including β‐adrenergic receptor signalling, G‐protein coupled receptor kinases, cardiomyocyte calcium physiology, myofilament physiology, cardiomyocyte gene expression, myocardial electrophysiology and arrhythmogenicity, myocardial inflammation, metabolism and energetics. The integrated effects upon ventricular haemodynamics are discussed and integrated into the pathophysiological model.

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“…This may explain our profound response to atropine in the absence of significant epinephrine response [ 3 ]. Paradoxical bradycardia in the setting of epinephrine administration is a rare but recognised phenomenon [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Profound Vagal Tone and Bradycardia Mimicking Asystole: A Resuscitation Case Report

Mannion

Chapman

Deasy

et al. 2022

Case Reports in Cardiology

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A 48-year-old man presented with dizziness. When he arrived at the emergency department, he collapsed and became pulseless. Prior to his collapse, he was asymptomatic and now even participated in multiple marathon and ultra-running events per year. However, he previously experienced a vasospastic inferior STEMI eight years prior from cocaine use. As a result, he had an ischaemic cardiomyopathy with LVEF of 45%. He never took any further illicit substances after the STEMI; instead, he changed his lifestyle completely and commenced extreme endurance sports. After one hour of alternations between VF/VT rhythms and asystole, a rhythm check demonstrated a single complex with a corresponding pulse. He had received 12 mg of epinephrine up to that point as per local resuscitation guidelines. Upon diagnosing extreme bradycardia, 2 mg of total atropine administration resulted in ROSC. We theorise that this bradycardia was a result of increased vagal tone as ROSC was quickly achieved following atropine administration.

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Paradoxical reflex bradycardia after epinephrine infusion for arrhythmia induction in the electrophysiology laboratory

Cited by 8 publications

References 7 publications

Stepwise approach to induce infrequent premature ventricular complex using bolus isoproterenol and epinephrine infusion

Stepwise approach to induce infrequent premature ventricular complex using bolus isoproterenol and epinephrine infusion

Profound Vagal Tone and Bradycardia Mimicking Asystole: A Resuscitation Case Report

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