Author + information
- Received January 5, 1987
- Revision received June 24, 1987
- Accepted July 7, 1987
- Published online December 1, 1987.
- L. Steven Zukerman, MD1,
- Ted D. Friehling, MD, FACC1,
- Nelson M. Wolf, MD, FACC1,
- Steven G. Meister, MD, FACC1,
- George Nahass, MD1 and
- Peter R. Kowey, MD, FACC*,1
- ↵*Address for reprints: Peter R. Kowey. MD, Division of Cardiology. Medical College of Pennsylvania. 3300 Henry Avenue, Philadelphia, Pennsylvania 19129.
Ventricular fibrillation during coronary angiography with Renografin-76 (meglumine sodium diatrizoate) has been attributed to the calcium-binding additives sodium citrate and sodium ethylenediaminetetraacetic acid (EDTA), which may produce repolarization changes manifested as prolongation of the QT interval. Angiovist-370 is a newer form of meglumine sodium diatrizoate that contains calcium EDTA as its additive and thus has a decreased calcium-binding effect. Eight hundred sixteen patients were prospectively randomized to receive either Renografin-76 or Angiovist-370. Ventricular fibrillation occurred in 10 of 410 patients receiving Renografin-76 and in 0 of 406 patients given Angiovist-370 (p < 0.0005).
Clinical data were analyzed without knowledge of other data in the 10 patients treated with Renografin-76 who had ventricular fibrillation (Group I), 103 randomly selected patients who also received Renografin-76 but had no ventricular fibrillation (Group II) and 108 randomly selected patients given Angiovist-370 (Group III). Of several variables examined, only the QT interval differentiated patients receiving Renografin-76 and Angiovist-370. The mean corrected QT interval (QTcinterval) before coronary angiography was slightly but not significantly (p = 0.7) higher in Group I than in Groups II and III. Ten seconds after the first left coronary artery injection it was more prolonged in Groups I and II (0.552 and 0.561 second, respectively) than in Group III (0.448 second) (p < 0.00005). Similarly, 10 seconds after the first right coronary artery injection it was significantly longer in Groups I and II (0.545 and 0.544 second) than in Group III (0.477 second) (p < 0.00005). The mean QTC interval after coronary angiography was slightly more prolonged in Groups I and II (0.469 and 0.455 second) compared with Group III (0.439 second) (p = 0.06).
Thus, the substitution of calcium EDTA in contrast agents significantly decreases the incidence of ventricular fibrillation during coronary angiography, perhaps by attenuating the repolarization changes (with resultant QT interval prolongation) induced by contrast agents.
- Received January 5, 1987.
- Revision received June 24, 1987.
- Accepted July 7, 1987.
- American College of Cardiology Foundation