Premium
Atropine for prevention of cardiac dysrhythmias in patients with hepatocellular carcinoma undergoing percutaneous ethanol instillation: a randomized, placebo‐controlled, double‐blind trial
Author(s) -
Arnulf Ferlitsch,
Monika Schmid,
Herwig Schmidinger,
Monika Homoncik,
Johannes PleinerDuxneuner,
Gregor Ulbrich,
Alfred Gangl,
Markus PeckRadosavljevic
Publication year - 2009
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/j.1478-3231.2008.01905.x
Subject(s) - medicine , hepatocellular carcinoma , placebo , percutaneous ethanol injection , atropine , randomized controlled trial , anesthesia , pathology , alternative medicine , radiofrequency ablation , ablation
Percutaneous ethanol injection (PEI) is an established method in the treatment of hepatocellular carcinoma (HCC). During this procedure, severe cardiac bradyarrhythmias can occur. A preemptive injection of atropine is recommended by professional guidelines to prevent these dysrhythmias. Methods: Patients scheduled for PEI were randomized 1:1 to receive 0.5 mg atropinehydrochloride or placebo in a double‐blind randomized placebo‐controlled trial. Patients were electrocardiogram monitored, which were then analysed by an experienced rhythmologist blinded to the treatment arm. Results: Patients in 40 consecutive PEI sessions were included. During PEI, a significant reduction in the mean heart rate (>15%) was seen in 15% of patients in the placebo group (median, −37%; range, 15–41%) and in 25% of patients receiving atropine (median, −20%; range, 16–64%). There was no significant difference between both groups. During PEI, two patients (10%) in the placebo group developed a sinuatrial block (SAB). Four patients in the atropine group (20%) developed arrhythmias: three patients SAB, one of them with escape rhythm and one AV‐bundle block. Blood ethanol levels post‐PEI, amount of instilled ethanol, tumour size and location were not different between patients with or without dysrhythmias. Conclusion: In this randomized‐controlled trial, a preprocedure atropine injection did not prevent the occurrence of bradyarrhythmias. Prophylactic use of atropine might not be effective and therefore cannot be recommended as a routine procedure. Clinicaltrials.gov‐identifier: NCT00575523.