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Influence of low osmolality contrast media on electrophysiology and hemodynamics in coronary angiography: differences
1Department of Clinical Physiology, Haukeland Hospital, University of Bergen, Norway.
Insights
Sodium-containing low osmolality contrast media, like ioxaglate, may prolong the QT interval and AH-interval during coronary angiography, unlike sodium-free iohexol. This suggests factors beyond osmolality influence electrophysiological effects.
Area of Science:
- Cardiology
- Radiology
- Pharmacology
Background:
- Low osmolality contrast media are used in coronary angiography.
- The role of sodium content in these media regarding electrophysiological effects is under investigation.
Purpose of the Study:
- To compare the electrophysiological and hemodynamic effects of sodium-containing (ioxaglate) versus sodium-free (iohexol) low osmolality contrast media during coronary angiography.
Main Methods:
- A randomized, double-blind study involving 30 patients undergoing coronary angiography.
- Monitoring included standard ECG, aortic blood pressure, and His bundle electrocardiogram.
- Comparison of ioxaglate and iohexol effects on cardiac intervals and hemodynamics.
Main Results:
- Both contrast media were well tolerated with no serious arrhythmias.
- Both induced transient decreases in systolic blood pressure and heart rate.
- Ioxaglate significantly prolonged the QT interval and AH-interval, while iohexol did not.
Conclusions:
- Sodium content, not just osmolality, may contribute to QT prolongation with low osmolality contrast media.
- Ioxaglate's sodium content appears linked to its observed electrophysiological effects, distinct from iohexol.
Abstract:
It has recently been suggested that the addition of sodium to low osmolality contrast media may reduce the incidence of ventricular fibrillation and conduction disturbances during coronary angiography. In a randomized, double blind study of 30 patients undergoing coronary angiography we therefore examined the electrophysiological and hemodynamic effects of the two low osmolality contrast media-ioxaglate (with sodium) and iohexol (without sodium). Standard ECG, aortic blood pressure, and His bundle electrocardiogram were recorded. The contrast media were well tolerated and no serious arrhythmias were observed. Both induced a transient decrement in systolic blood pressure and reduction in heart rate 10 s following contrast injection (all P less than 0.01). Ioxaglate prolonged the QT interval at 10 s (P less than 0.01) and also when analysed for the whole observation period (120 s) (P less than 0.05), whereas iohexol did not cause any significant changes in the QT-interval. The AH-interval was prolonged by ioxaglate at 10 s (P less than 0.01), but not altered by iohexol. Thus, other factors than osmolality and sodium content might contribute to QT prolongation, since only the contrast agents with sodium (ioxaglate) induced QT prolongation in this study.