A-44 | Intravenous aminophylline for preventing bradyarrhythmias during coronary atherectomy (2022)

BackgroundAminophylline, an adenosine antagonist, can be used to prevent adenosine-mediated bradyarrhythmias. No robust data exist on its use to prevent bradyarrhythmias in patients undergoing coronary atherectomy.MethodsRetrospective, observational study of patients undergoing coronary atherectomy with prophylactic intravenous (IV) aminophylline. The primary composite outcome was the occurrence of a clinically significant documented bradyarrhythmia and the use of any pharmacologic intervention (e.g. atropine) and/or rescue temporary pacemaker (TPM) implantation. Patients with prophylactic TPM without aminophylline pretreatment served as a comparator group.ResultsA total of 345 consecutive patients were included, amongst which 301 received IV aminophylline pretreatment and 44 had prophylactic TPM without aminophylline pretreatment. The primary outcome occurred in 6 (2.0%) patients with aminophylline pre-treatment and 1 (2.3%) patient with prophylactic TPM (p=0.9). None of the patients that received aminophylline pretreatment required rescue TPM. There were no differences between aminophylline pretreatment and prophylactic TPM with respect to documented bradyarrhythmias (2.7% vs. 2.3%, p=0.8) or pharmacologic interventions (14% vs. 23%, p=0.1). The most common pharmacologic intervention was the use of intravenous atropine.ConclusionsIn patients undergoing rotational atherectomy, aminophylline pretreatment was associated with a similar frequency of bradyarrhythmias and need for pharmacologic interventions as prophylactic TPM. Given the latter is an invasive strategy with associated procedural risks and higher costs, aminophylline represents a safe, cost-effective, prophylactic strategy with similar effectiveness.DisclosuresJ. D. Knott Nothing to disclose. A. H. Hassan Nothing to disclose. J. Gladden Nothing to disclose. B. R. Lewis Nothing to disclose. M. R. Bell Nothing to disclose. D. R. Holmes Jr. Nothing to disclose. N. Brinkman Nothing to disclose. B. Konz Nothing to disclose. M. Singh Nothing to disclose. C. S. Rihal Nothing to disclose. G. W. Barsness Nothing to disclose. A. Prasad Nothing to disclose. G. Sandhu Nothing to disclose. R. Gulati Nothing to disclose. Y. B. Sandoval Nothing to disclose. BackgroundAminophylline, an adenosine antagonist, can be used to prevent adenosine-mediated bradyarrhythmias. No robust data exist on its use to prevent bradyarrhythmias in patients undergoing coronary atherectomy. Aminophylline, an adenosine antagonist, can be used to prevent adenosine-mediated bradyarrhythmias. No robust data exist on its use to prevent bradyarrhythmias in patients undergoing coronary atherectomy. MethodsRetrospective, observational study of patients undergoing coronary atherectomy with prophylactic intravenous (IV) aminophylline. The primary composite outcome was the occurrence of a clinically significant documented bradyarrhythmia and the use of any pharmacologic intervention (e.g. atropine) and/or rescue temporary pacemaker (TPM) implantation. Patients with prophylactic TPM without aminophylline pretreatment served as a comparator group. Retrospective, observational study of patients undergoing coronary atherectomy with prophylactic intravenous (IV) aminophylline. The primary composite outcome was the occurrence of a clinically significant documented bradyarrhythmia and the use of any pharmacologic intervention (e.g. atropine) and/or rescue temporary pacemaker (TPM) implantation. Patients with prophylactic TPM without aminophylline pretreatment served as a comparator group. ResultsA total of 345 consecutive patients were included, amongst which 301 received IV aminophylline pretreatment and 44 had prophylactic TPM without aminophylline pretreatment. The primary outcome occurred in 6 (2.0%) patients with aminophylline pre-treatment and 1 (2.3%) patient with prophylactic TPM (p=0.9). None of the patients that received aminophylline pretreatment required rescue TPM. There were no differences between aminophylline pretreatment and prophylactic TPM with respect to documented bradyarrhythmias (2.7% vs. 2.3%, p=0.8) or pharmacologic interventions (14% vs. 23%, p=0.1). The most common pharmacologic intervention was the use of intravenous atropine. A total of 345 consecutive patients were included, amongst which 301 received IV aminophylline pretreatment and 44 had prophylactic TPM without aminophylline pretreatment. The primary outcome occurred in 6 (2.0%) patients with aminophylline pre-treatment and 1 (2.3%) patient with prophylactic TPM (p=0.9). None of the patients that received aminophylline pretreatment required rescue TPM. There were no differences between aminophylline pretreatment and prophylactic TPM with respect to documented bradyarrhythmias (2.7% vs. 2.3%, p=0.8) or pharmacologic interventions (14% vs. 23%, p=0.1). The most common pharmacologic intervention was the use of intravenous atropine. ConclusionsIn patients undergoing rotational atherectomy, aminophylline pretreatment was associated with a similar frequency of bradyarrhythmias and need for pharmacologic interventions as prophylactic TPM. Given the latter is an invasive strategy with associated procedural risks and higher costs, aminophylline represents a safe, cost-effective, prophylactic strategy with similar effectiveness. In patients undergoing rotational atherectomy, aminophylline pretreatment was associated with a similar frequency of bradyarrhythmias and need for pharmacologic interventions as prophylactic TPM. Given the latter is an invasive strategy with associated procedural risks and higher costs, aminophylline represents a safe, cost-effective, prophylactic strategy with similar effectiveness.