Key result
Amiodarone during therapeutic hypothermia increases epicardial electrical heterogeneity and inducible ventricular arrhythmias in pigs.
Why the study?
Electrophysiological changes and proarrhythmic risk following amiodarone treatment have not been explored under therapeutic hypothermia.
Does amiodarone treatment during therapeutic hypothermia alter electrophysiological parameters and vulnerability to ventricular arrhythmias in a pig model?
Does amiodarone treatment during therapeutic hypothermia alter electrophysiological parameters and vulnerability to ventricular arrhythmias in a pig model?
In a preclinical pig model, amiodarone treatment during therapeutic hypothermia increased epicardial electrical heterogeneity and vulnerability to inducible ventricular arrhythmias.
May warrant caution with amiodarone during therapeutic hypothermia; leaves open translation to humans.
BACKGROUND: Amiodarone is commonly used during therapeutic hypothermia (TH) following cardiac arrest due to ventricular arrhythmias. However, electrophysiological changes and proarrhythmic risk after amiodarone treatment have not yet been explored in TH. METHODS: Epicardial high-density bi-ventricular mapping was performed in pigs under baseline temperature (BT), TH (32-34°C), and amiodarone treatment during TH. The total activation time (TAT), conduction velocity (CV), local electrogram (LE) duration, and wavefront propagation from pre-specified segments were analyzed during sinus rhythm (SR) or right ventricular (RV) pacing (RVP), along with tissue expression of connexin 43. The vulnerability to ventricular arrhythmias was assessed. RESULTS: Compared to BT, TH increased the global TAT, decreased the CV, and generated heterogeneous electrical substrate during SR and RVP. During TH, the CV reduction and LE duration prolongation were greater in the anterior mid RV than in the other areas, which changed the wavefront propagation in all animals. Compared to TH alone, amiodarone treatment during TH further increased the TAT and LE duration and decreased the CV. Heterogeneous conduction was partially attenuated after amiodarone treatment. After TH and amiodarone treatment, the connexin 43 expression in the anterior mid RV was lower than that in the other areas, compatible with the heterogeneous CV reduction. The animals under TH and amiodarone treatment had a higher incidence of inducible ventricular arrhythmias than those under BT or TH without amiodarone. CONCLUSION: Electrical heterogeneity during amiodarone treatment and TH was associated with vulnerability to ventricular arrhythmias.
No takes yet. Share an insight, caveat, or question.
Lin et al. (2023) studied Ventricular arrhythmias during therapeutic hypothermia. Amiodarone during therapeutic hypothermia vs. Baseline temperature or therapeutic hypothermia without amiodarone was evaluated on Vulnerability to ventricular arrhythmias and electrophysiological changes (TAT, CV, LE duration). Amiodarone treatment during therapeutic hypothermia in pigs increased epicardial electrical heterogeneity and resulted in a higher incidence of inducible ventricular arrhythmias.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: