Background

Rotational atherectomy (RA) may cause bradyarrhythmias and transitory atrioventricular block when performed in the right coronary artery (RCA) or a dominant circumflex (CX) coronary artery. However, there are no studies of a solution that can prevent coronary flow deterioration and bradycardia complications that may occur during RA. We aimed to create an alternative rota-flush solution to minimize the risk of bradycardia and complete atrioventricular block (AVB) that can occur during RA.

Materials and methods

The study comprised 60 patients who were randomly divided into two groups: 30 received rotaphylline (= 240 mg aminophylline, 10,000 U unfractionated heparin, and 2000 mcg nitroglycerin to 1000 mL saline), and 30 received the traditional rota-flush (= 10,000 U unfractionated heparin, 2000 mcg nitroglycerin, and 1000 mL saline). The incidence of bradycardia or high-grade AVB (HAVB) during RA, coronary slow-flow phenomenon or no-reflow phenomenon, and coronary spasm were the primary endpoints of the study. Procedure success and RA-related procedural complications were secondary endpoints.

Results

The use of rotaphylline was an independent predictor of bradycardia and HAVB after accounting for all other factors (OR: 0.47, 95% CI: 0.24–0.79, p < 0.001). Lesion length (OR: 2.17, 95% CI: 1.24–3.04, p < 0.001), burr-to-artery ratio (OR: 0.59, 95% CI: 0.39–1.68, p < 0.001), and total run duration (OR: 0.79, 95% CI: 0.35–1.43, p < 0.001) were additional independent predictors.

Conclusion

Bradycardia and the development of HAVB may be avoided by rotaphylline intracoronary infusion during RA applied to the RCA and dominant CX lesions. Multicenter studies including sizable patient populations should be conducted to validate the present findings.

中文翻译：

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氨茶碱和肝素加硝酸甘油的混合物可以减少右冠状动脉和优势旋支动脉旋磨术期间的心动过缓

背景

当在右冠状动脉 (RCA) 或主回旋支 (CX) 冠状动脉中进行旋转斑块旋切术 (RA) 时，可能会导致缓慢性心律失常和短暂性房室传导阻滞。然而，目前还没有研究可以预防 RA 期间可能发生的冠状动脉血流恶化和心动过缓并发症的解决方案。我们的目标是创建一种替代的旋转冲洗解决方案，以最大限度地降低 RA 期间可能发生的心动过缓和完全性房室传导阻滞 (AVB) 的风险。

材料和方法

该研究包括 60 名患者，他们被随机分为两组：30 名接受罗塔茶碱（= 240 mg 氨茶碱、10,000 U 普通肝素和 2000 mcg 硝酸甘油加入 1000 mL 生理盐水），30 名接受传统 rota-flush（= 10,000 U 普通肝素）肝素、2000 mcg 硝酸甘油和 1000 mL 生理盐水）。RA期间心动过缓或高度AVB（HAVB）的发生率、冠状动脉慢血流现象或无复流现象以及冠状动脉痉挛是该研究的主要终点。手术成功和 RA 相关手术并发症是次要终点。

结果

考虑所有其他因素后，使用罗茶碱是心动过缓和 HAVB 的独立预测因子（OR：0.47，95% CI：0.24–0.79，p  < 0.001）。病变长度（OR：2.17，95% CI：1.24–3.04，p  < 0.001）、毛刺与动脉比率（OR：0.59，95% CI：0.39–1.68，p  < 0.001）和总运行持续时间（OR ：0.79，95% CI：0.35–1.43，p  < 0.001）是额外的独立预测因子。

结论

在对 RCA 和主要 CX 病变进行 RA 期间，通过冠状动脉内输注罗茶碱可以避免心动过缓和 HAVB 的发生。应进行包括大量患者群体的多中心研究来验证目前的研究结果。