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- Title
Production of arrhythmias by elevated carboxyhemoglobin in patients with coronary artery disease.
- Authors
Sheps, David S.; Herbst, Margaret C.; Hinderliter, Alan L.; Adams, Kirkwood F.; Ekclund, Lars G.; O'Neil, John J.; Goldstein, George M.; Bromberg, Philip A.; Dalton, Janice L.; Ballenger, Martha N.; Davis, Sonia M.; Koch, Gary G.; Sheps, D S; Herbst, M C; Hinderliter, A L; Adams, K F; Ekelund, L G; O'Neil, J J; Goldstein, G M; Bromberg, P A
- Abstract
<bold>Objective: </bold>To assess the effects of exposure to 4% and 6% carboxyhemoglobin on ventricular arrhythmias in patients with coronary artery disease.<bold>Design: </bold>Randomized, double-blind, crossover design.<bold>Setting: </bold>Exercise laboratory with an environmentally controlled exposure.<bold>Patients: </bold>Forty-one nonsmokers with documented coronary artery disease.<bold>Intervention: </bold>On day 1, a training session with no exposure, the baseline carboxyhemoglobin level was measured, and a supine bicycle exercise test was done. On days 2 to 4, patients were exposed to room air, 100 ppm carbon monoxide (target, 4% carboxyhemoglobin) or 200 ppm carbon monoxide (target, 6% carboxyhemoglobin), and they then did supine bicycle exercise with radionuclide ventriculography. Ambulatory electrocardiogram recordings were made during the 4 consecutive days to determine the frequency of ventricular premature depolarization (VPD) at various intervals.<bold>Measurements and Main Results: </bold>The frequency of single VPD/h was significantly greater on the 6% carboxyhemoglobin day than on the room air day during the exercise period (167.72 +/- 37.99 for 6% carboxyhemoglobin compared with 127.32 +/- 28.22 for room air, P = 0.03). During exercise, the frequency of multiple VPD/h was greater on the 6% carboxyhemoglobin day compared with room air (9.59 +/- 3.70 on the 6% carboxyhemoglobin compared with 3.18 +/- 1.67 on room air, P = 0.02). Patients who developed increased single VPD during exercise on the 6% carboxyhemoglobin day were significantly older than those who had no increased arrhythmia, whereas patients who developed complex arrhythmias were also older and, in addition, exercised longer and had a higher peak workload during exercise.<bold>Conclusion: </bold>The number and complexity of ventricular arrhythmias increases significantly during exercise after carbon monoxide exposure producing 6% carboxyhemoglobin compared with room air but not after exposure producing 4% carboxyhemoglobin.
- Subjects
PHYSIOLOGICAL effects of carbon monoxide; ARRHYTHMIA; CORONARY disease; CORONARY heart disease complications; AGE distribution; AIR pollution; CARBON monoxide; CLINICAL trials; COMPARATIVE studies; EXERCISE tests; CARDIAC radionuclide imaging; HEMODYNAMICS; RESEARCH methodology; MEDICAL cooperation; MEDICAL protocols; RESEARCH; STATISTICAL sampling; TIME; EVALUATION research; CARBOXYHEMOGLOBIN; RANDOMIZED controlled trials; BLIND experiment
- Publication
Annals of Internal Medicine, 1990, Vol 113, Issue 5, p343
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/0003-4819-113-5-343