Cognitive dysfunction after ventricular fibrillation during implantable cardiovertor/defibrillator procedures is related to duration of the reperfusion interval

Anesthesia and Analgesia
J M MurkinR Yee

Abstract

The insertion of implantable cardioverter/defibrillators (ICD) requires induction of repeated episodes of ventricular fibrillation (VF). The neuropsychological repercussions associated with repeated inducement of hypotension and cerebral ischemia are unknown. In this prospective clinical trial, 1 day prior to ICD assessment/implantation and 5 days postprocedure, 14 patients underwent neurological and cognitive screening. Cognitive dysfunction was defined as impaired performance in one of four cognitive domains. Neurological impairment was defined as a decrement of 2 or more points from baseline of a total possible score of 45 points. Intraoperative hemodynamics, including the reperfusion interval (RI; end of preceding fibrillation to beginning of the next), were recorded. Patients underwent an average of 12 +/- 6 episodes of VF with average duration of mean arterial pressure (MAP) <50 mm Hg for 17 +/- 9 s (range 6-39 s) and of MAP <30 mm Hg for 11 +/- 5 s (range 2-22 s). Nine patients, in none of whom the predetermined criteria for neurologic impairment was met, demonstrated a new subtle neurologic finding postoperatively. Ten of 14 patients met the criterion for cognitive dysfunction 5 days postoperatively. The mean RI between...Continue Reading

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