Recommendations for performing acetylcholine tests safely: STOP dangerous complications induced by acetylcholine tests (STOP DCIAT).

Abstract

OBJECTIVES:

We examined some recommendations for performing acetylcholine (ACh) tests safely.

METHODS AND RESULTS:

We performed 1000 ACh tests from 1991 to December 2004. ACh was injected in incremental doses of 20/50/80 microg into the RCA and of 20/50/100 microg into the LCA. During these periods, we encountered various major/minor complications; 12 ventricular tachycardia (1.2%) necessary one dc, one ventricular fibrillation (0.1%) necessary dc, 3 shock like the left main stem spasm (0.3%), one cardiac tamponade necessary surgical drainage (0.1%), and 164 Paf (164/959:17.1%) necessary administration of antiarrhythmic agents to sinus rhythm in about one third patients (31.7%). We did not experience irreversible severe complications, such as acute myocardial infarction or death.

RECOMMENDATIONS:

(1) Stand by direct current with pasting, (2) Thump version when ventricular tachycardia or fibrillation occurred, (3) Over infusion to avoid hypovolemia, (4) Perform angiography before complete spasm provocation if a severe spasm, (5) Drainage if cardiac tamponade occurred, (6) Cibenzoline or disopyramid administration when ACh induced paroxysmal atrial fibrillation, (7) Incremental ACh dose up should be performed, (8) Administer small amount of noradrenaline if shock observed and (9) Test shot should be performed before 1-min angiography.

CONCLUSIONS:

We recommend STOP DCIAT for performing ACh tests safely.

• Authors: Shozo Sueda, Akira Oshita, Takahiko Nomoto, Yousuke Izoe, Hiroaki Kohno, Hiroshi Fukuda, Kazuaki Mineoi, Takaaki Ochi, Tadao Uraoka
• Journal: Journal of cardiology (J Cardiol) Vol. 51 Issue 2 Pg. 131-4 (Apr 2008) ISSN: 0914-5087 [Print] Netherlands
• PMID: 18522786 (Publication Type: Journal Article)

Chemical References

• Acetylcholine

Topics

• Acetylcholine (adverse effects)
• Aged
• Atrial Fibrillation (chemically induced, prevention & control)
• Cardiac Tamponade (chemically induced, prevention & control)
• Coronary Angiography
• Coronary Vasospasm (diagnosis)
• Humans
• Male
• Middle Aged
• Tachycardia, Ventricular (chemically induced, prevention & control)
• Ventricular Fibrillation (chemically induced, prevention & control)