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A mix of aminophylline and heparin plus nitroglycerin can reduce bradycardia during rotational atherectomy on the right coronary artery and dominant circumflex artery

Eine Mischung aus Aminophyllin und Heparin plus Nitroglycerin kann Bradykardie während Rotations-Atherektomie der A. coronaria dextra und des dominanten Ramus circumflexus vermindern

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Abstract

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.

Zusammenfassung

Hintergrund

Eine Rotations-Atherektomie (RA) kann Bradyarrhythmien und einen transitorischen Atrioventrikularblock (AVB) verursachen, wenn sie in der A. coronaria dextra (RCA) oder in einem dominanten Ramus circumflexus (CX) durchgeführt wird. Es gibt jedoch keine Studien hinsichtlich einer Lösung, mit der die Verhinderung einer Flussverminderung in den Koronarien und bradykarder Komplikationen, die bei einer RA auftreten können, möglich wird. Ziel der Autoren war es, eine alternative Rota-Flush-Lösung zu entwickeln, um das Risiko einer Bradykardie und eines kompletten AVB, die während einer RA auftreten können, zu minimieren.

Material und Methoden

An der Studie nahmen 60 Patienten teil, die randomisiert in 2 Gruppen aufgeteilt wurden: So erhielten 30 Rotaphyllin (240 mg Aminophyllin, 10.000 U unfraktioniertes Heparin und 2000 μg Nitroglycerin auf 1000 ml Kochsalzlösung) und 30 die traditionelle Rota-Flush-Lösung (10.000 U unfraktioniertes Heparin, 2000 μg Nitroglycerin und 1000 ml Kochsalzlösung). Primäre Endpunkte der Studie waren die Inzidenz einer Bradykardie oder eines hochgradigen AVB (HAVB) während einer RA, ein koronares Slow-Flow-Phänomen oder No-Reflow-Phänomen sowie Koronarspasmen. Der Erfolg des Verfahrens und RA-bezogene Verfahrenskomplikationen waren sekundäre Endpunkte.

Ergebnisse

Die Verwendung von Rotaphyllin war ein unabhängiger Prädiktor einer Bradykardie und eines HAVB nach Berücksichtigung sämtlicher anderer Faktoren (Odds Ratio, OR: 0,47; 95 %-Konfidenzintervall, 95 %-KI: 0,24–0,79; p < 0,001). Die Länge der Läsion (OR 2,17; 95 %-KI: 1,24–3,04; p < 0,001), das Verhältnis zwischen Bohrer und Arterie (OR 0,59; 95 %-KI: 0,39–1,68; p < 0,001) und die Gesamtbetriebsdauer (OR 0,79; 95 %-KI: 0,35–1,43; p < 0,001) waren zusätzliche unabhängige Prädiktoren.

Schlussfolgerung

Eine Bradykardie und die Entwicklung eines HAVB können durch die intrakoronare Infusion von Rotaphyllin während der RA von Läsionen der RCA und eines dominanten CX verhindert werden. Multizenterstudien mit großen Patientenpopulationen sollten durchgeführt werden, um die vorliegenden Ergebnisse zu validieren.

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Authors and Affiliations

  1. Faculty of Medicine, Department of Cardiology, Abant Izzet Baysal University, Bolu, Turkey

    Emrah Acar M.D., Ibrahim Donmez M.D., Eda Ozcan M.D., Tuba Kaygusuz M.D., Yilmaz Güneş M.D. & Ibrahim Akin Izgi M.D.

  2. Kartal Koşuyolu Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey

    Servet Izci M.D. & Cevat Kirma M.D.

  3. Cardiology Department, Kastamonu Training and Research Hospital, Kastamonu, Turkey

    Neryan Ozgul M.D.

  4. Cardiology Department, Cankiri State Hospital, Cankırı, Turkey

    Oguz Kayabası M.D.

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  1. Emrah Acar M.D.
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Correspondence to Emrah Acar M.D..

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E. Acar, S. Izci, I. Donmez, N. Ozgul, E. Ozcan, T. Kaygusuz, O. Kayabası, Y. Güneş, I.A. Izgi and C. Kirma declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case.

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Acar, E., Izci, S., Donmez, I. et al. A mix of aminophylline and heparin plus nitroglycerin can reduce bradycardia during rotational atherectomy on the right coronary artery and dominant circumflex artery. Herz 48, 480–486 (2023). https://doi.org/10.1007/s00059-023-05195-1

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