The impact of preprocedural aminophylline administration on the development of bradyarrhythmias and hemodynamic changes during rotational atherectomy

Cha, Kwang Soo; Kim, Moo Hyun; Kim, Young Dae; Kim, Jin Woo; Kim, Shin Jae; Kim, Jong Seong

Abstract

BACKGROUND: Rotational atherectomy or rotablation in right coronary artery (RCA) or dominant left circumflex artery (LCX) can cause bradyarrhythmias and requires the placement of prophylactic pacemaker. Adenosine is released endogenously by ischemic or hypoxic cells and mediates the bradyarrhythmias associated with impaired coronary flow. Aminophylline, an adenosine receptor antagonist, is known to prevent hypoxic bradyarrhythmias. The purpose of this study was to assess the impact of preprocedural aminophylline administration on the development of bradyarrhythmias and hemodynamic changes during rotablation.
METHODS
High-speed rotablation was performed using a stepped burr approach in 38 patients following intravenous infusion of aminophylline (381.3+/-38.5 mg). The development of transient bradyarrhythmias and change of blood pressure and heart rate during the rotablation were assessed.
RESULTS
Mean age was 56.9+/-8.8 years and 76% of the patients was male. Sixty-six percent of the patients has multivessel coronary artery disease and mean ejection fraction was 58%. Mean lesion length was 19.2+/-9.8 mm and RCA or dominant LCX lesions were 32 (84%). Mean burr/artery ratio was 0.61+/-0.05, maximum burr used was 1.69+/-0.16 mm, including 2.0 mm in 5 (13%) lesions, and mean ablation number was 6.4+/-2.8. Rotablation was successful without no reflow phenomenon in all patients. Low-pressure balloon angioplasty in all lesions and additional stenting in 24 (63%) lesions were followed. Neither severe discomfort nor serious arrhythmia occurred during the procedures. Systolic blood pressure and heart rate were not changed significantly before and after the aminophylline infusion, and during the rotablation (121.5+/-18.0 vs. 108.7+/-17.3 vs. 109.3+/-16.9 mmHg, p=0.062; 72.6+/-12.1 vs. 78.4+/-16.5 vs. 75.9+/-15.5 bpm, p=0.084, respectively). No bradyarrhythmias occurred during the rotablation with prior aminophylline infusion. Plasma aminophylline level measured after the procedure in 19 patients was 9.8+/-1.9 micro gram/mL.
CONCLUSION
Preprocedural aminophylline administration may prevent the development of bradyarrhythmias during rotablation without significant hemodynamic changes. It seems a useful measure to obviate unfavorable pacing or even routine prophylactic placement of a pacemaker during the rotablation employing small burrs.