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Bradycardia and sinus arrest during percutaneous ethanol injection therapy for hepatocellular carcinoma
Author(s) -
Ferlitsch A.,
Kreil A.,
Bauer E.,
Schmidinger H.,
Schillinger M.,
Gangl A.,
PeckRadosavljevic M.
Publication year - 2004
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/j.1365-2362.2004.01321.x
Subject(s) - medicine , bradycardia , sinus bradycardia , anesthesia , percutaneous ethanol injection , hepatocellular carcinoma , atrioventricular block , percutaneous , heart rate , cardiology , surgery , radiofrequency ablation , ablation , blood pressure
Background Percutaneous ethanol injection (PEI) is an established method in the treatment of hepatocellular carcinoma (HCC) and considered a safe procedure, with severe complications occurring rarely. Cardiac arrhythmias have not been reported to date. Aim of the study was to investigate the occurrence of dysrhythmias during PEI. Patients and methods Twenty‐six consecutive patients with inoperable HCC were included. During ultrasound‐guided PEI with 95% ethanol, electrocardiogram (ECG) monitoring was performed before starting and continuously during PEI. Results During PEI a significant reduction in mean heart rate (> 20%) was seen in 15 of 26 (58%) patients. In 11 of 26 patients (42%) occurrence of sinuatrial block (SAB) or atrioventricular block (AVB) was observed after a median time of 9 s (range 4–50) from the start of PEI with a median length of 24 s (range 12–480). Clinical symptoms were seen in two patients, including episodes of unconsciousness, seizure‐like symptoms in both and a respiratory arrest during PEI in one patient, requiring mechanical ventilation. In four of 12 patients with repeat interventions, dysrhythmias were reproducible during monthly performed procedures. There was a significant association between the occurrence of SAB or AVB and the amount of instilled alcohol ( P = 0·03) and post‐PEI serum ethanol levels ( P = 0·03). Conclusions Bradycardia and block formation occur frequently during PEI. These symptoms could be explained by a vasovagal reaction and/or the direct effect of ethanol on the sinus node or the right atrial conduction system. Ethanol dose is an important factor for the occurrence of SAB/AVB. ECG‐monitoring seems mandatory during PEI. Prophylactic use of intravenously administered Atropine might be useful.