Arrhythmias During Upper Gastrointesintal Endoscopy P. K.
Mathew, M.D., F.A.C.A. Fernando V. Ona, M.D., Kiril Damevski, M.D., and Wayne A. Wallace, M.D. ROCHESTER, NEW YORK
Abstract
Electrocardiographic monitoring of 52 consecutive patients undergoing upper gastrointestinal endoscopy revealed that arrhythmias during the procedures were common (38.5%) and tended to occur more frequently in the elderly (75%), in persons with heart disease (54.5%), and in persons with chronic lung disease (89%). The incidence of ventricular premature contractions in patient with no evidence of heart or lung disease was 19%. In one patient with advanced chronic lung disease, the procedure had to be terminated because of development of high-degree atrioventricular block. A high incidence of arrhythmias during endoscopy has not been previously reported in patients with chronic lung disease. I~?l,rndZZ~tiotZ
Electrocardiographic (ECG) abnormalities have been described during various endoscopic procedures. Schuman et al.’ noted a 36% incidence of transient ECG changes during gastroscopy. Other studies have revealed 27.5%,2 36.7%3 and 72.2%4 incidences of transient ECG abnormalities. These studies confirmed that patients with heart disease have a significantly greater incidence of ECG abnormalities during gastroscopy. However, the incidence of ECG abnormalities during gastroscopy in patients with chronic lung disease is not known. Furthermore, in many of the previous studies a continuous ECG recording by the Holter technique was not used, and sinus tachycardia was considered as a form of arrhythmia. We consider sinus tachycardia as a normal reaction to the stress of gastroscopy and to premedication with at-
ropine. Materials and Methods
Fifty-two unselected consecutive patients undergoing upper gastrointestinal endoscopy for various indications were studied. Thirty-four were men and 18 Department of Medicine, University Mary’s Hospital, Rochester, New York. From the
St.
of
Rochester, School of Medicine and Dentistry, and
834
Downloaded from ang.sagepub.com at TU Muenchen on July 3, 2015
835
age was 60 years (range 23-84 years). Twenty-eight patients were below the age of 60, and 24 patients were 60 or older. The patients’ past and present medical histories, ECGs, chest x-rays, and laboratory data (including arterial blood gases, electrolytes, hematocrit, and pulmonary function test results, if available) were reviewed in detail before the endoscopic procedure. All patients had a 12-lead ECG before the procedure. Each patient was electrocardiographically monitored continuously before, during, and after endoscopy by the Holter technique (Electrocardiocorder model 385, Avionics). The Holter monitoring was begun before premedication, which consisted of atwere
women; the
mean
and in most cases parenteral diazepam. The gastroscopy was carried out with an Olympus GIFD~ gastroscope after the throat was topically anesthetized with Cetacaine 2% spray. After the procedure was over, the electrocardiographic recordings were reviewed by one of the authors (PKM), without knowledge of the clinical diagnosis of the patient. The patients were grouped into three categories depending on the presence of organic heart disease or pulmonary disease. Group I consisted of 32 patients without evidence of organic heart disease or pulmonary disease. The average age of this group was 53 years. Two patients showed rare APCs and VPCs on the resting electrocardiogram. Group II consisted of 11 patients with definite heart disease, based on the history, clinical signs of congestive heart failure requiring digitalis and/or diuretic therapy, documented old myocardial infarction, unequivocal evidence of cardiomegaly on chest x-rays, or definite signs of ischemia or an old infarction pattern in a resting 12-lead ECG. In 7 patients coronary artery disease was the primary cardiac disease; in 1, hypertensive disease; and in 3 patients, rheumatic heart disease. The patients with isolated ECG evidence of certain conduction disturbances (first-degree A-V block, left anterior hemiblock, RBBB, LBBB) and left ventricular hypertrophy alone were not included in this group. The average age of this group was 70.5 years. Three patients in this group had VPCs on resting ECG, and 4 were in chronic atrial fibrillation. Group III consisted of 9 patients with definite evidence of chronic lung disease as indicated by typical clinical history, arterial blood gases, chest x-ray, and pulmonary function tests. The mean age of this group was 74.5 years. Two patients had rare APCs and VPCs on the resting ECG, and 2 were in chronic atrial fibrillation.
ropine, meperidine,
_
’
Results
Arrhythmias. New arrhythmias were recorded during the endoscopic procedure in 20 patients (38.5%) (Tables 1 and 2). However, only 6 patients (19%) in Group I (no heart or lung disease) had new arrhythmias during the procedure. In Group II (heart disease) the incidence was 54.5%. However, the 3 patients
Downloaded from ang.sagepub.com at TU Muenchen on July 3, 2015
836 TABLE 1
.
Electrocardiographic Changes During Gastroscopy
*
Compared to Group I, P t Compared to Group I, P
Mathew, M.D., F.A.C.A. Fernando V. Ona, M.D., Kiril Damevski, M.D., and Wayne A. Wallace, M.D. ROCHESTER, NEW YORK
Abstract
Electrocardiographic monitoring of 52 consecutive patients undergoing upper gastrointestinal endoscopy revealed that arrhythmias during the procedures were common (38.5%) and tended to occur more frequently in the elderly (75%), in persons with heart disease (54.5%), and in persons with chronic lung disease (89%). The incidence of ventricular premature contractions in patient with no evidence of heart or lung disease was 19%. In one patient with advanced chronic lung disease, the procedure had to be terminated because of development of high-degree atrioventricular block. A high incidence of arrhythmias during endoscopy has not been previously reported in patients with chronic lung disease. I~?l,rndZZ~tiotZ
Electrocardiographic (ECG) abnormalities have been described during various endoscopic procedures. Schuman et al.’ noted a 36% incidence of transient ECG changes during gastroscopy. Other studies have revealed 27.5%,2 36.7%3 and 72.2%4 incidences of transient ECG abnormalities. These studies confirmed that patients with heart disease have a significantly greater incidence of ECG abnormalities during gastroscopy. However, the incidence of ECG abnormalities during gastroscopy in patients with chronic lung disease is not known. Furthermore, in many of the previous studies a continuous ECG recording by the Holter technique was not used, and sinus tachycardia was considered as a form of arrhythmia. We consider sinus tachycardia as a normal reaction to the stress of gastroscopy and to premedication with at-
ropine. Materials and Methods
Fifty-two unselected consecutive patients undergoing upper gastrointestinal endoscopy for various indications were studied. Thirty-four were men and 18 Department of Medicine, University Mary’s Hospital, Rochester, New York. From the
St.
of
Rochester, School of Medicine and Dentistry, and
834
Downloaded from ang.sagepub.com at TU Muenchen on July 3, 2015
835
age was 60 years (range 23-84 years). Twenty-eight patients were below the age of 60, and 24 patients were 60 or older. The patients’ past and present medical histories, ECGs, chest x-rays, and laboratory data (including arterial blood gases, electrolytes, hematocrit, and pulmonary function test results, if available) were reviewed in detail before the endoscopic procedure. All patients had a 12-lead ECG before the procedure. Each patient was electrocardiographically monitored continuously before, during, and after endoscopy by the Holter technique (Electrocardiocorder model 385, Avionics). The Holter monitoring was begun before premedication, which consisted of atwere
women; the
mean
and in most cases parenteral diazepam. The gastroscopy was carried out with an Olympus GIFD~ gastroscope after the throat was topically anesthetized with Cetacaine 2% spray. After the procedure was over, the electrocardiographic recordings were reviewed by one of the authors (PKM), without knowledge of the clinical diagnosis of the patient. The patients were grouped into three categories depending on the presence of organic heart disease or pulmonary disease. Group I consisted of 32 patients without evidence of organic heart disease or pulmonary disease. The average age of this group was 53 years. Two patients showed rare APCs and VPCs on the resting electrocardiogram. Group II consisted of 11 patients with definite heart disease, based on the history, clinical signs of congestive heart failure requiring digitalis and/or diuretic therapy, documented old myocardial infarction, unequivocal evidence of cardiomegaly on chest x-rays, or definite signs of ischemia or an old infarction pattern in a resting 12-lead ECG. In 7 patients coronary artery disease was the primary cardiac disease; in 1, hypertensive disease; and in 3 patients, rheumatic heart disease. The patients with isolated ECG evidence of certain conduction disturbances (first-degree A-V block, left anterior hemiblock, RBBB, LBBB) and left ventricular hypertrophy alone were not included in this group. The average age of this group was 70.5 years. Three patients in this group had VPCs on resting ECG, and 4 were in chronic atrial fibrillation. Group III consisted of 9 patients with definite evidence of chronic lung disease as indicated by typical clinical history, arterial blood gases, chest x-ray, and pulmonary function tests. The mean age of this group was 74.5 years. Two patients had rare APCs and VPCs on the resting ECG, and 2 were in chronic atrial fibrillation.
ropine, meperidine,
_
’
Results
Arrhythmias. New arrhythmias were recorded during the endoscopic procedure in 20 patients (38.5%) (Tables 1 and 2). However, only 6 patients (19%) in Group I (no heart or lung disease) had new arrhythmias during the procedure. In Group II (heart disease) the incidence was 54.5%. However, the 3 patients
Downloaded from ang.sagepub.com at TU Muenchen on July 3, 2015
836 TABLE 1
.
Electrocardiographic Changes During Gastroscopy
*
Compared to Group I, P t Compared to Group I, P
