Transitional changes of acetylcholine spasm provocation test procedures
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ORIGINAL ARTICLE
Transitional changes of acetylcholine spasm provocation test procedures Shozo Sueda1 · Hiroaki Kohno2 Received: 23 July 2019 / Accepted: 24 September 2019 © Japanese Association of Cardiovascular Intervention and Therapeutics 2019
Abstract Intracoronary acetylcholine (ACh) testing has become popular in the world as a spasm provocation test as well as an ergonovine test. Intracoronary ACh test based on the Japanese Circulation Society guidelines is necessary to insert a temporary pace maker (PM). We analyzed the ACh spasm provocation test procedures retrospectively. We performed 1829 ACh spasm provocation testing during 28 years. We investigated the procedural approach sites of artery and vein. Femoral artery and vein approach, brachial artery and femoral vein approach, brachial artery and vein approach, radial artery and brachial vein approach, radial artery and femoral vein approach were performed in 292 patients (16.0%), 498 patients (27.2%), 589 patients (32.2%), 252 patients (13.8%), and 175 patients (9.6%), respectively. We could perform the ACh testing by the femoral artery and brachial artery in all patients, while the success rate of radial artery approach was 97.1%. We could also insert the temporary PM by the brachial vein in 94.8% (841/887) of the study patients, whereas we could insert the temporary PM in all femoral vein approach [100% (965/965)]. We experienced the pulmonary embolism by the femoral artery and vein approach in two patients, while we also had the arterio-venous fistula necessary for surgical repair in two patients by the brachial artery and vein approach. Although there was no difference about the procedure-related major complications among the various procedures, we had no pulmonary embolism or arterio-venous fistula by the radial artery and brachial vein approach. Considering the disinfection with povidone iodine, procedural performance or procedure-related complications by the ACh testing, we recommend that radial artery and brachial vein approach is more comfortable method of the future ACh testing not only for patients but also for operators. Keywords Brachial vein · Radial artery · Acetylcholine · Spasm provocation test
Introduction Intracoronary acetylcholine (ACh) testing was first reported by Yasue and Okumura in 1986 [1]. ACh test as a spasm provocation test has become spread over the world as well as ergonovine tests [2–5]. Because intracoronary injection of ACh may have a potential to cause a transient block or bradycardia, we should insert the temporary pace maker (PM) into the right ventricle during the ACh testing based on the Japanese Circulation Society (JCS) guidelines [6]. * Shozo Sueda [email protected] 1
The Department of Cardiology, Ehime Prefectual Niihama Hospital, Hongou 3 Choume 1‑1, Niihama City, Ehime Prefecture 792‑0042, Japan
Department of Cardiology, Tsukazaki Hospital, Himeji, Japan
2
Recently, the radial artery approach becomes popular in the world due to comfortable for patients. Furthermore, we can select a vein access r
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