Safety and efficacy of early atropine injection for dobutamine stress cardiac magnetic resonance: a single center experience

Introduction Dobutamine is an effective pharmacologic stress agent commonly used in cardiac stress testing, but has several well documented adverse effects including serious arrhythmias and myocardial infarction. The most common dobutamine protocol is to infuse an increasing dose of 10 μg/kg followed by 20, 30, then 40 μg/kg until target HR is achieved. Atropine may be added after the 40 μg/kg infusion if target heart rate is not achieved. An alternative strategy for dobutamine infusion involves earlier atropine administration, i.e. infusion of atropine after the 10, 20, or 30 μg/kg doses of dobutamine. In the echocardiography literature this strategy has been shown to have a better safety profile while maintaining the ability to achieve target heart rate. Dobutamine stress CMR may benefit from adopting a similar protocol.