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LETTER TO EDITOR
Year : 2012  |  Volume : 60  |  Issue : 5  |  Page : 528-530

Transient ventricular bigeminy during vertebral artery catheterization


Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Medical College PO, Thiruvananthapuram, Kerala, India

Date of Web Publication3-Nov-2012

Correspondence Address:
Kamble Jayaprakash Harsha
Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Medical College PO, Thiruvananthapuram, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.103210

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How to cite this article:
Harsha KJ, Jayadevan ER, Kannath SK. Transient ventricular bigeminy during vertebral artery catheterization. Neurol India 2012;60:528-30

How to cite this URL:
Harsha KJ, Jayadevan ER, Kannath SK. Transient ventricular bigeminy during vertebral artery catheterization. Neurol India [serial online] 2012 [cited 2020 Feb 18];60:528-30. Available from: http://www.neurologyindia.com/text.asp?2012/60/5/528/103210


Sir,

A 31-year-old male, with past history of non- ST elevation myocardial infarction in February 2012, presented with sudden onset right-sided weakness of one month duration. Magnetic resonance imaging (MRI) showed infarct in left middle cerebral artery territory and MR angiography showed severe left internal carotid artery (ICA) stenosis. He was taken up for diagnostic cerebral digital subtraction angiography (DSA) for further evaluation. Continuous monitoring of electrocardiography (ECG), pulse oximeter oxygen saturation (SpO 2 ), and heart rate was done as a standard protocol. Carotid angiogram revealed left ICA occlusion. Left vertebral artery (VA) catheterization was attempted as catheterization of right VA resulted in severe arterial spasm. Left VA was arising directly from aortic arch. Initial attempt to catheterize left A resulted in ventricular bigeminy. Catheter tip was withdrawn immediately. After sometime left VA catheterization was again attempted, while catheter was in-situ in left VA, ventricular bigeminy recurred which disappeared with the withdrawal of catheter [Figure 1]. Patient remained asymptomatic throughout the procedure. No fluctuations in blood pressure, SpO 2 , or sweating were noted throughout the procedure, particularly during the period of ventricular bigeminy.
Figure 1: (a) Initial vital monitoring revealed normal sinus rhythm of ECG and pulse waves. (b) During period of initial left vertebral artery catheterization, ventricular bigeminy was noted, which disappeared after catheter withdrawal. (c) Reappearance of ventricular bigeminy during second time attempt of left vertebral artery catheterization

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This patients was not on any drugs or had any metabolic abnormalities that can cause ventricular ectopic. [1] Metabolic parameters done just prior to the procedure were normal. Cardiac causes like acute and chronic ischemic heart disease, cardiomyopathy, valvular heart disease, mitral valve prolapse can cause ventricular ectopic. Though our patient had chronic ischemic heart disease, previous normal sinus rhythm and peculiarly the phenomenon of bigeminy only during vertebral artery catheterization makes the heart disease also less likely cause. Among cerebral lesions, insular stroke, cortical and diencephalic tumors are reported to cause cardiac arrhythmias. [2],[3],[4] Mechanism of ventricular bigeminy following vertebral artery catheterization in our patient is unclear. Severe spasm of right vertebral artery during catheterization by glide catheter would suggest sympathetic hyperactivity of cerebral vessels. Possibly ventricular bigeminy in our patient can be secondary to sympathetic stimulation by the catheter. Psychological factors and stress leading to upregulation and dysfunction of sympathetic system might be an additive factor. This unique observation in this patient emphasizes the importance of continuous monitoring of ECG, heart rate, and SpO 2 during any cerebral angiographic procedure.

 
  References Top

1.Hebbar AK, Hueston WJ. Management of common arrhythmias: Part II. Ventricular arrhythmias and arrhythmias in special populations. Am Fam Physician 2002;65:2491-6.  Back to cited text no. 1
    
2.Iwashita T, Kitazawa K, Koyama J, Nagashima H, Koyama T, Aruga M, Tanaka Y, et al. Middle cerebral artery occlusion associated with acute myocardial infarction in the perioperative period--case report. Neurol Med Chir (Tokyo) 2006;46:88-91.  Back to cited text no. 2
    
3.Leung RS, Diep TM, Bowman ME, Lorenzi-Filho G, Bradley TD. Provocation of ventricular ectopy by cheyne-stokes respiration in patients with heart failure. Sleep 2004;27:1337-43.  Back to cited text no. 3
    
4.Oppenheimer S. Cerebrogenic cardiac arrhythmias: Cortical lateralization and clinical significance. Clin Auton Res 2006;16:6-11.  Back to cited text no. 4
    


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