Author + information
- Received May 15, 1992
- Revision received July 15, 1992
- Accepted July 20, 1992
- Published online February 1, 1993.
- Thomas E. Dahms, PhD∗,
- Liwa T. Younis, MD, PhD,
- Robert D. Wiens, MD, FACC,
- Shahriar Zarnegar, BS,
- Shelia L. Byers, RN and
- Bernard R. Chaitman, MD, FACC
- ↵∗Address for correspondence: Thomas E. Dahms, PhD, Department of Anesthesiology, Saint Louis University School of Medicine, 3635 Vista Avenue, Saint Louis, Missouri 63110-0250.
Objective. This study was designed to determine whether carbon monoxide has proarrhythmic effects at rest and during upright exercise in patients with myocardial ischemia and moderate baseline ectopic activity.
Background. Exposure of patients with documented myocardial ischemia to low levels of carboxyhemoglobin (COHb) alters the myocardial response to exercise. Anecdotal reports from patients with myocardial ischemia have noted the development of arrhythmias related to carbon monoxide exposure. Increased frequency of arrhythmias related to carbon monoxide exposure in patients performing supine bicycle exercise has been recently reported.
Methods. Twenty-eight nonsmoking men and five nonsmoking women with documented coronary artery disease and a minlmum of 30 ventricular ectopic beats/h over a 20-h period were studied. Subjects were exposed in a randomized double-blind fashion to either room air or sufficient carbon monoxide to elevate their COHb concentration to 3% or 5% in 1 h, followed by a maintenance exposure to carbon monoxide, The subjects then left the laboratory and resumed their normal daily activity to determine changes in ventricular ectopic beats after carbon monoxide exposure.
Results. There was no significant change in the frequency of single ventricular ectopic beats at rest from 115 ± 28 (in room air) to 121 ± 31 at 3% COHb to 94 ± 23 at 5% COHb. Exercise itself Increased the frequency of ventricular ectopic beats, but there was no additional effect of carbon monoxide exposure on the exerciseinduced increase in isolated ectopic beats or complex ectopic waveforms. Analysis of the data based on grouping of the subjects by the severity of disease (ventricular ectopic beat frequency, ejection fraction, presence of exercise-induced ischemia) indicated no proarrhythmic effect of carbon monoxide.
Conclusions. In patients with frequent ventricular ectopic activity (≥30 ectopic beats/h), exposure to carbon monoxide producing either 3% or 5% COHb does not increase arrhythmia frequency of single or multiple beats during rest or exercise.
☆ This study was conducted under contiacl to the Health Effects Institute (HEI), an organization jointly funded by the U.S. Environmental Pretection Agency (EPA) (Assistance Agreement X-812059) and automotive manufacturers. The contenls of this article do not necessarily reflect the views of the HEI or the policies of the EPA or the automotive manufacturers.
- Received May 15, 1992.
- Revision received July 15, 1992.
- Accepted July 20, 1992.