Aminophylline for Preventing Bradyarrhythmias during Orbital or Rotational Atherectomy of the Right Coronary Artery

Michael Megaly, Yader Sandoval, Matthew P. Lillyblad, Emmanouil S. Brilakis

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

BACKGROUND: Coronary atherectomy, orbital or rotational, is frequently used for plaque modification in patients with heavily calcified lesions. Atherectomy can be associated with clinically significant bradyarrhythmias or transient atrioventricular block requiring temporary pacemaker insertion, mainly in lesions involving the right coronary artery or a dominant left circumflex artery. Bradyarrhythmias may be mediated by endogenous release of adenosine from red blood cell breakdown. Aminophylline, an adenosine antagonist, can prevent adenosine-mediated bradyarrhythmias. METHODS: This retrospective analysis examined 7 patients in whom aminophylline (250-300 mg intravenously over 10 min) was administered before coronary atherectomy. The study endpoint was the occurrence of any bradyarrhythmia. RESULTS: Orbital atherectomy was used in 3 cases, rotational atherectomy was used in 3 cases, and both systems were used in 1 case. Technical success was 100% and all patients had Thrombolysis in Myocardial Infarction 3 flow at the end of the procedure. Preprocedural aminophylline administration successfully prevented bradyarrhythmias or atrioventricular block in all cases. CONCLUSIONS: Intravenous aminophylline represents a simple, safe, widely available, and low-cost intervention for preventing bradyarrhythmias during atherectomy of the right coronary artery or a dominant circumflex artery.

Original languageEnglish (US)
Pages (from-to)186-189
Number of pages4
JournalJournal of Invasive Cardiology
Volume30
Issue number5
StatePublished - May 1 2018

Keywords

  • aminophylline
  • atherectomy
  • bradycardia

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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