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European Heart Journal 1992 13(9):1277-1281;
Copyright © 1992 by the European Society of Cardiology.
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© 1992 The European Society of Cardiology

Effect of fentanyl on cardiac automaticity and conduction: direct or mediated action?

L. ALVAREZ*,, C. ESCUDERO*, J. A. CARMONA{dagger}, L. SILVA{ddagger} and J. L. CASTILLO-OLIVARES*

*Services of Experimental Surgery, Clinica Puerto de Hierro Madrid, Spain
{dagger}Anesthesiology and Reanimation, Clinica Puerto de Hierro Madrid, Spain
{ddagger}Cardiology, Clinica Puerto de Hierro Madrid, Spain

Received 22 May 1991; revised 27 September 1991; .

Correspondence: Dra L. Alvarez, Rafael Bergamin, 9, 28043 Madrid, Spain

Abstract

The effects of fentanyl at a dose of 100 µg. kg–1on cardiac automaticity, refractoriness and conduction have been studied in a model of heterotopic heart transplantation which combines a denervated heart (donor) and a non-denervated heart (recipient) in each of 20 dogs employed. Once the surgical procedure had been completed, cycle length, sinoatrial conduction time, antegrade and retrograde A-V node block points, cycle length at which 1:1 conduction ceases to exist and the antegrade effective refractory period of the A-V node and ventricles were measured. These parameters were determined in hearts both in the basal situation and 10 min after fentanyl injection. In the recipient organs, fentanyl produced statistically significant prolongation of cycle length, sinoatrial conduction time, antegrade block point and antegrade effective refractory periods of the A-V node and ventricles, with respect to the basal situation (P < 001 for all these parameters); in 20% of cases, a complete A-V block was produced. In the donor hearts (denervated), prolongations of cycle length (P < 001) and the antegrade block point (P < 0·05), as compared with the basal situation, were recorded, but no other modifications were detected.

To test whether these effects were due to the action of fentanyl, 10 animals were subsequently injected with naloxone, an agent which reverted the reported changes, although in the recipient organs, there persisted a slight prolongation of the cycle length with respect to basal measurements (P < 005).

From these results, it can be deduced that, at least in dogs, fentanyl may have two mechanisms of action: the first, already recognized, consists of vagus nerve stimulation, and the second appears to act directly on the sinus and A-V nodes.

Key Words: Denervated heart • electrophysiology • fentanyl


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