Abstract
In 1975, Tuttle and Mills published an article on a new catecholamine discovered in 1970: dobutamine. Tuttle, a pharmacologist, and Mills, a chemist, modified the structure of isoprenaline to obtain a new drug. Isoprenaline through its action on β adrenergic receptors increases the cardiac contractility with the cost of an increased heart rate and proarrhythmic effect associated with an increase in blood pressure. After removing the hydroxyl group from isoproterenol, the new compound had a positive chronotropic and inotropic effect. By substitution of the side chains, they obtained a compound with less chronotropic effect that reduced the arrhythmogenic properties of the product. Dobutamine has a direct ß1 and ß2 stimulation effect with a dose-related increase in heart rate, myocardial contractility, and blood pressure. Dobutamine increases regional myocardial blood flow but at a dose of 20 μg/kg/min induces coronary flow heterogeneity less than that induced by Dipyridamole or Adenosine. Since it has no action on dopamine receptors, to induce norepinephrine release, is less prone to induce hypertension than is dopamine. Dobutamine has also a mild ß2 agonist activity, making it useful as a vasodilator Dobutamine increases the automaticity of the sinoatrial node and decreases the refractory period of the atrium and atrio-ventricular node as well as the atrio-ventricular conduction time. It also decreases the refractory period of both ventricles, healthy or ischemic. It was also demonstrated in the study of Masoni et al. that dobutamine decreases the sinus cycle length, the SNRT, and corrected SNRT. At the atrial and nodal levels, it decreases the AH interval, Wenckebach cycle length, AV nodal functional and effective refractory periods. Dobutamine has no effect on the HV interval. Besides an increase in the heart rate, dobutamine induces ventricular premature contractions in 3–15% of patients. Ventricular tachycardia can be induced by dobutamine infusion in a small percentage of patients. Ischemic patients, those with heart failure and known arrhythmias, are at higher risk of proarrhythmia.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Tuttle RR, Millis J. Dobutamine: development of a new cathecolamine to selectively increase the cardiac contractility. Circ Res. 1975;36:185–96.
Tuttle RR. Inotropic and cronotropic effects of dobutamine and isoproterenol on cat atria and papillary muscles at different temperatures (abstr). Fed Proc. 1974;33:503.
Henzlova MJ, et al. ASNC imaging guidelines for nuclear cardiology procedures: stress protocols and tracers. J Nucl Cardiol. 2009.
Yan M, Webster LT Jr, Blumer JL. Kinetic interactions of dopamine and dobutamine with human catechol-O-methyltransferase and monoamine oxidase in vitro. J Pharmacol Exp Ther. 2002;301:1–7.
Masoni A, Alboni P, Malacarne C, et al. Effects of dobutamine on electrophysiological properties of the specialized conduction system in man. J Electrocardiol. 1979;12:361–70.
McNally EM. Can we do better than Dobutamine? Circ Res. 2013;113:355–7.
Nachar RA, Booth EA, Friedlich P, Borzage M, Soleymani S, et al. Dose-dependent hemodynamic and metabolic effects of vasoactive medications in normotensive, anesthetized neonatal piglets. Pediatr Res. 2011;70:473–9.
McGovern JJ, Cheifetz IM, Craig DM, Bengur AR, Quick G, et al. Right ventricular injury in young swine: effects of catecholamines on right ventricular function and pulmonary vascular mechanics. Pediatr Res. 2000;48:763–9.
Ferrara JJ, Dyess L, Peeples GL, Christenberry P, Roberts WS, et al. Effects of dopamine and dobutamine on regional blood flow distribution in the neonatal piglet. Ann Surg. 1995;221:531–42.
Leighton KM, Bruce C. Dobutamine and general anaesthesia: a study of the response of arterial pressure, heart rate and renal blood flow. Can Anaesth Soc J. 1976;23:176–84.
Bednarski RM, Muir WW. Arrhythmogenicity of dopamine, dobutamine, and epinephrine in thiamylalhalothane anesthetized dogs. Am J Vet Res. 1983;44:2341–3.
Parratt JR, Wainwright CL, Fagbemi O. Effect of dopexamine hydrochloride in the early stages of experimental myocardial infarction and comparison with dopamine and dobutamine. Am J Cardiol. 1988;62:18C–23C.
Kirlin PC, Pitt B, Lucchesi BR. Comparative effects of prenalterol and dobutamine in a canine model of acute ischemic heart failure. J Cardiovasc Pharmacol. 1981;3:896–905.
Ozaki T, Uematsu T, Nagashima S, et al. Effects of DPI 201-106, a novel cardiotonic agent, on hemodynamics, cardiac electrophysiology and arrhythmias induced by programmed ventricular stimulation in dogs with subacute myocardial infarction: a comparative study with dobutamine. Arch Pharmacol. 1991;344:478–87.
Vanegas DI, de Montenegro J, de Perez C, Orjuela A. Dobutamine use for arrhythmia induction during electrical programmed heart stimulation. Revista Colombiana de Cardiologia. 2006;12:479–83.
Leier CV, Webel J, Bush CA. The cardiovascular effects of the continuous infusion of dobutamine in patients with severe cardiac failure. Circulation. 1977;56:468–72.
Leier CV, Heban PT, Huss P, et al. Comparative systemic and regional hemodynamic effects of dopamine and dobutamine in patients with cardiomyopathic heart failure. Circulation. 1978;58:466–75.
David S, Zaks JM. Arrhythmias associated with intermittent outpatient dobutamine infusion. Angiology. 1986;37:86–91.
Gillespie TA, Ambos HD, Sobel BE, et al. Effects of dobutamine in patients with acute myocardial infarction. Am J Cardiol. 1977;139:588–94.
Berthe C, Pierard LA, Hiernaux M, et al. Predicting the extent and location of coronary artery disease in acute myocardial infarction by echocardiography during dobutamine infusion. Am J Cardiol. 1986;158:1167–72.
Guimon J-G, Matuschak GM, Meyers F, et al. Augmentation of cardiac function in end-stage heart failure by combined use of dobutamine and amrinone. Chest. 1986;90:302–4.
Dies F, Krell MJ, Whitlow P. Intermittent dobutamine in ambulatory outpatients with chronic cardiac failure. Circulation. 1986;74:11–38.
Mertes H, Sawada SG, Ryan T, et al. Symptoms, adverse effects, and complications associated with dobutamine stress echocardiography: experience in 1118 patients. Circulation. 1993;88:15–9.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Nasra, A.W. (2019). How to Induce Arrhythmias with Dobutamine. In: Cismaru, G. (eds) Arrhythmia Induction in the EP Lab. Springer, Cham. https://doi.org/10.1007/978-3-319-92729-9_8
Download citation
DOI: https://doi.org/10.1007/978-3-319-92729-9_8
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-92728-2
Online ISBN: 978-3-319-92729-9
eBook Packages: MedicineMedicine (R0)