Abstract：
BACKGROUND:Early defibrillation clearly improves survival from malignant arrhythmia. However, in some cases the cause of death will only be altered from arrhythmic to nonarrhythmic. We evaluated the impact of left ventricular ejection fraction (LVEF) on trend and recovery profile of beat-to-beat cardiac output (CO) and mean arterial blood pressure (MAP) after successful defibrillation. METHODS:We investigated 63 NYHA class I-III patients undergoing threshold testing in the course of insertion of an implantable cardioverter defibrillator (ICD) in monitored anaesthesia care. Preoperatively, LVEF was classified as either normal (>50%), moderately (30-50%) or severely impaired (<30%). CO and MAP were measured continuously throughout the implantation procedure. RESULTS:Arrest time and body mass index were not different between groups. CO in patients with severely and moderately reduced LVEF dropped 21% and 13% below baseline (P<0.05), respectively. MAP also decreased by 26% and 17%, respectively. In contrast, 45% of patients with LVEF>50% showed sympathetic activation that resulted in a 12% and 2% increase in mean values for CO and MAP, respectively. In relation to patients with LVEF<50%, CO and MAP values were significantly higher after defibrillation (P<0.05). Additionally, recovery of CO was prolonged in the groups with ventricular dysfunction (P<0.05). Temporary post-shock pacing was observed in 40% of patients. CONCLUSIONS:A large number of ICD patients with restricted LVEF appears to lack the ability to quickly restore CO and MAP after successful defibrillation. Organ reperfusion may thus still be compromised.
journal_name
Resuscitationjournal_title
Resuscitationauthors
Skhirtladze K,Mora B,Moritz A,Birkenberg B,Ankersmit HJ,Dworschak Mdoi
10.1016/j.resuscitation.2010.06.004subject
Has Abstractpub_date
2010-09-01 00:00:00pages
1123-7issue
9eissn
0300-9572issn
1873-1570pii
S0300-9572(10)00324-2journal_volume
81pub_type
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