CRT-100.62 Safety and Efficacy of Aminophylline in the Prevention of Bradyarrhythmias During Coronary Atherectomy

Document Type

Conference Proceeding

Publication Date


Publication Title

JACC Cardiovasc Interv


Background: Microembolization and endogenous release of adenosine during coronary atherectomy particularly in vessels supplying the atrioventricular node can result in clinically significant bradyarrhythmias. Approaches to mitigate bradyarrhythmias include the preemptive use of a transvenous pacemaker, aminophylline, atropine, or conservative management utilizing shorter cycles of atherectomy with longer intervals between cycles of atherectomy. The use of aminophylline to prevent bradyarrhythmias is variable amongst clinicians and limited data exist regarding the safety and efficacy of its use. Methods: We identified all patients who were administered aminophylline in the cardiac catheterization laboratory between 10/1/2018 and 4/1/2021. All patients who received aminophylline and underwent orbital or rotational atherectomy during the same procedure were included in the present analysis. Electronic medical records were retrospectively reviewed to collect demographics, procedural characteristics, and clinical outcomes. Safety endpoints included intraprocedural use of a transvenous pacemaker, atropine, inotropes, vasopressors or mechanical circulatory support; procedural complications related to urgent TVP, adverse reaction to aminophylline, and survival to discharge. Results: During the study period, 138 patients received IV aminophylline during coronary atherectomy on a total of 159 lesions. Orbital atherectomy was used in 58%, rotational atherectomy in 48%, and both orbital and rotational atherectomy in 7%. Technical success was achieved in 98.6% of cases. Concomitant intraprocedural use of atropine occurred in 18% of cases. Six patients (4.3%) had intraprocedural insertion of a transvenous pacemaker after administration of aminophylline and no complications occurred during placement of TVP. There were no adverse reactions to aminophylline and all patients survived to discharge. Conclusions: Use of intravenous aminophylline is a safe and effective option for the prevention of bradyarrhythmias during coronary atherectomy and use of a bailout TVP is required in <5% of patients.



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