Recovery of Ventriculo-Atrial Conduction after Adrenaline in Patients Implanted with Pacemakers

• Published in: Pacing and clinical electrophysiology Vol. 38; no. 7; pp. 857 - 863
• Main Authors: CISMARU, GABRIEL, GUSETU, GABRIEL, MURESAN, LUCIAN, ROSU, RADU, ANDRONACHE, MARIUS, MATUZ, ROXANA, PUIU, MIHAI, MESTER, PETRU, MICLAUS, MARIA, POP, DANA, MIRCEA, PETRU ADRIAN, ZDRENGHEA, DUMITRU
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01-07-2015
• Subjects: adrenaline; Aged; Atrioventricular Block - diagnosis; Atrioventricular Block - etiology; Atrioventricular Block - prevention & control; endless loop tachycardia; Epinephrine - administration & dosage; Female; Humans; ICD; Male; pacemaker syndrome; Pacemaker, Artificial - adverse effects; Premedication - methods; Prosthesis Implantation; Recovery of Function; Sympathomimetics - administration & dosage; Treatment Outcome; ventriculoatrial conduction; endless loop tachycardia; ICD; ventriculoatrial conduction; adrenaline; pacemaker syndrome
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/pace.12641

Background
Ventriculo‐atrial (VA) conduction can have negative consequences for patients with implanted pacemakers and defibrillators. There is concern whether impaired VA conduction could recover during stressful situations. Although the influence of isoproterenol and atropine are well established, the effect of adrenaline has not been studied systematically. The objective of this study was to determine if adrenaline can facilitate recovery of VA conduction in patients implanted with pacemakers.
Methods
A prospective study was conducted on 61 consecutive patients during a 4‐month period (April–July 2014). The presence of VA conduction was assessed during the pacemaker implantation procedure. In case of an impaired VA conduction, adrenaline infusio was used as a stress surrogate to test conduction recovery.
Results
The indications for pacemaker implantation were: sinus node dysfunction in 18 patients, atrioventricular (AV) block in 40 patients, binodal dysfunction (sinus node+ AV node) in two patients and other (carotid sinus syndrome) in one patient. In the basal state, 15/61 (24.6%) presented spontaneous VA conduction and 46/61 (75.4%) had no VA conduction. After administration of adrenaline, there was VA conduction recovery in 5/46 (10.9%) patients.
Conclusions
Adrenaline infusion produced recovery of VA conduction in 10.9% of patients with absent VA conduction in a basal state. Recovery of VA conduction during physiological or pathological stresses could be responsible for the pacemaker syndrome, PMT episodes, or certain implantable cardiac defibrillator detection issues.