Bradycardia and asystole with the use of vagus nerve stimulation for the treatment of epilepsy:: A rare complication of intraoperative device testing
Bradycardia and asystole with the use of vagus nerve stimulation for the treatment of epilepsy:: A rare complication of intraoperative device testing
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DOI：
10.1111/j.1528-1157.1999.tb02019.x
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发表时间：
1999-10-01
期刊：
影响因子：
5.6
通讯作者：
Duffell, WH
中科院分区：
文献类型：
--
作者：
Asconapé, JJ;Moore, DD;Duffell, WH
目的：一位56岁的男性，患有轻度精神发育迟滞、右侧先天性轻偏瘫和难治性部分性癫痫发作，被转诊接受迷走神经刺激（VNS）。外科手术期间的常规电极导线诊断测试（1.0 mA，20 Hz和500 μ s，持续类似于17 s）导致，在最初的两次刺激期间，第三次尝试导致短暂的心搏停止，需要阿托品和简短的心肺复苏术。结果：手术立即终止，设备取出，病人完全康复。术后的心脏评估，包括心电图，24小时霍尔特心电图，超声心动图，和倾斜试验，是normal.Conclusions：心动过缓/心搏停止的可能机制包括刺激颈迷走神经的心脏分支，无论是通过侧支电流传播或直接无意中放置的电极在这些分支之一;电极插入脉冲发生器不当，导致刺激强度不稳定变化;极性相反;以及过敏个体的特异性反应。制造商报告称，类似于3，500个植入物，该术中事件的发生率约为1/875或0.1%。
Purposes: A 56-year-old man with mild mental retardation, right congenital hemiparesis, and refractory partial seizures was referred for vagus nerve stimulation (VNS).Methods: Routine lead diagnostic testing during the surgical procedure (1.0 mA, 20 Hz, and 500 mu s, for similar to 17 s) resulted, during the initial two stimulations, in a bradycardia of similar to 30 beats/min. A third attempt led to transient asystole that required atropine and brief cardiopulmonary resuscitation.Results: The procedure was immediately terminated, the device removed, and the patient recovered completely. A postoperative cardiologic evaluation, including an ECG, 24-h Holter monitor, echocardiogram, and a tilt-table test, was normal.Conclusions: Possible mechanisms for the bradycardia/asystole include stimulation of cervical cardiac branches of the vagus nerve either by collateral cur rent spread or directly by inadvertent placement of the electrodes on one of these branches; improper plugging of the electrodes into the pulse generator, resulting in erratic varying intensity of stimulation; reverse polarity; and idiosyncratic-type reaction in a hypersusceptible individual. The manufacturer reports the occurrence rate in similar to 3,500 implants for this intraoperative event to be approximately one in 875 cases or 0.1%.