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Incidence of Cardiac Arrhythmias With Therapeutic Versus Diagnostic Ultrasound and Intravenous Microbubbles

University of Nebraska Medical Center, Omaha, Nebraska USA.

Address correspondence to Thomas R. Porter, MD, Section of Cardiology, University of Nebraska Medical Center, 981165 Nebraska Medical Center, Omaha, NE 68198-1165 USA. E-mail: trporter{at}unmc.edu

Objective. The purpose of this study was to determine the type of arrhythmias induced with therapeutic versus diagnostic transthoracic low-frequency ultrasound (TLFUS) transducers in the presence of intravenous microbubbles. Methods. Intravenous perfluorocarbon-exposed sonicated dextrose albumin (PESDA) microbubbles were infused or given as a bolus injection while TLFUS was applied in the standard parasternal and apical views with either a 1-MHz therapeutic ultrasound transducer or high-mechanical-index diagnostic ultrasound (1.7 MHz). Results. Significantly more ectopy was produced by the therapeutic transducer, especially at higher-intensity settings in the continuous wave mode after bolus injections of PESDA (P < .001 compared with lower intensities and lower continuous infusion rates). Six patients (15%) had either clinical supraventricular tachycardia or nonsustained ventricular tachycardia after intravenous PESDA with therapeutic TLFUS. In comparison, diagnostic high-mechanical-index ultrasound produced only isolated ventricular ectopy and no sustained ventricular arrhythmias. Conclusions. Intravenously injected microbubbles and low-frequency therapeutic transducers operating at longer duty cycles and wide beam widths have the capability of eliciting clinically important arrhythmias in patients at high risk for such events.

Key Words: arrhythmias • echocardiography • ultrasound contrast

Abbreviations: CW, continuous wave • EPS, electrophysiologic study • NSVT, nonsustained ventricular tachycardia • PAC, premature atrial contraction • PCMB, perfluorocarbon-containing microbubble • PESDA, perfluorocarbon-exposed sonicated dextrose albumin • PVC, premature ventricular contraction • PW, pulsed wave • SVT, supraventricular tachycardia • TLFUS, transthoracic low-frequency ultrasound • VT, ventricular tachycardia

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