July 27, 1999Circulation
Selective Activation of the K+ATPChannel Is a Mechanism by Which Sudden Death Is Produced by Low-Energy Chest-Wall Impact (Commotio Cordis)
Key result
In a swine model of commotio cordis, glibenclamide significantly reduced the incidence of ventricular fibrillation following T-wave impacts compared to control (4% vs 33%; P=0.01).
Why the study?
Does glibenclamide reduce ventricular fibrillation and ST-segment elevation in a swine model of commotio cordis?
Population
26 juvenile swine in a model of commotio cordis (subjected to 30-mph baseball impacts to the precordium)
Comparison
Glibenclamide 0.5 mg/kg IV vs Control vehicle or no glibenclamide
Design
Preclinical, Randomized, Double-blind fashion
Authors
Discussion
Loading...
Member takes
Implication
Hypothesis-generating for KATP blockade in commotio cordis; leaves open human translation and clinical trials.
Key Points
- To determine whether selective activation of the ATP-sensitive potassium channel mediates ventricular fibrillation and ST-segment elevation following low-energy chest-wall impacts in commotio cordis.
- Tested 0.5 mg/kg IV glibenclamide, a selective K+ATP channel blocker, in 6 juvenile swine subjected to QRS-timed chest impacts compared to untreated animals.
- Randomized 20 swine in a double-blind protocol to receive glibenclamide or a control vehicle prior to 30-mph baseball chest impacts timed immediately before the T-wave peak.
- Maximal ST-segment elevation after QRS impacts was significantly reduced in glibenclamide-treated animals (0.16±0.10 mV) compared to controls (0.35±0.20 mV; P=0.004).
- Glibenclamide significantly lowered the rate of ventricular fibrillation during T-wave impacts to 4% (1 episode in 27 impacts) compared to 33% in controls (6 episodes in 18 impacts; P=0.01).
Study Design
Type
RCT (n=26)
Blinding
Double-blind
Randomization
Randomized
Structured PICO
Does glibenclamide reduce ventricular fibrillation and ST-segment elevation in a swine model of commotio cordis?
P
Population
26 juvenile swine in a model of commotio cordis (subjected to 30-mph baseball impacts to the precordium)
I
Intervention
Glibenclamide 0.5 mg/kg IV (selective inhibitor of the K+ATP channel)
C
Comparator
Control vehicle or no glibenclamide
O
Outcome
Magnitude of ST-segment elevation (with QRS impacts) and incidence of ventricular fibrillation (with T-wave impacts)surrogate
Main Result
Absolute Event Rate: 4% vs 33%
p-value: p=0.01
In a swine model of commotio cordis, K+ATP channel blockade with glibenclamide reduced ST elevation and ventricular fibrillation, implicating this channel's activation as a key mechanism in sudden death from low-energy chest-wall trauma.
Cite This Study
Link et al. (1999) conducted an RCT in Commotio cordis (n=26). Glibenclamide vs. Control vehicle was evaluated on Ventricular fibrillation following T-wave impacts (p=0.01). In a swine model of commotio cordis, glibenclamide significantly reduced the incidence of ventricular fibrillation following T-wave impacts compared to control (4% vs 33%; P=0.01).