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Contrast media-induced ventricular fibrillation. A comparison of Hypaque-76, Hexabrix, and Omnipaque
Z E Piao1, D K Murdock, M H Hwang
1Department of Medicine, Hines Veterans Administration Hospital, IL 60141.
Insights
Conventional contrast media can cause ventricular fibrillation. Low osmolar agents like Hexabrix and Omnipaque are less likely to induce this dangerous arrhythmia during coronary angiography compared to Hypaque-76.
Area of Science:
- Cardiology
- Radiology
- Pharmacology
Background:
- Contrast media are used in coronary angiography.
- Some contrast media can induce ventricular fibrillation.
Purpose of the Study:
- To compare the arrhythmogenic potential of three contrast media: Hypaque-76 (H76), Hexabrix (HB), and Omnipaque (OM).
Main Methods:
- Open-chest anesthetized dogs underwent intracoronary injections of contrast media.
- Ventricular fibrillation propensity was assessed with spontaneous injections and programmed electrical stimulation.
- QT interval changes were measured.
Main Results:
- Hypaque-76 induced ventricular fibrillation in 40% of dogs spontaneously, Hexabrix in 20%, and Omnipaque in 0%.
- With programmed stimulation, Hypaque-76 induced fibrillation in 100% of dogs, Hexabrix in 30%, and Omnipaque in 0%.
- Hypaque-76 caused the greatest QT interval prolongation, followed by Hexabrix, then Omnipaque.
Conclusions:
- Low osmolar contrast media (Hexabrix and Omnipaque) are less arrhythmogenic than conventional ionic Hypaque-76.
- Nonionic Omnipaque demonstrates the lowest fibrillatory propensity among the tested agents.
Abstract:
Contrast media occasionally produce ventricular fibrillation during coronary angiography. We compared the fibrillatory propensity of the conventional ionic contrast medium, Hypaque-76 (H76) to the low osmolar ionic dimer Hexabrix (HB) and to the nonionic agent Omnipaque (OM) in 20 open chest anesthetized dogs. Intracoronary injection of 6 mL of contrast medium produced spontaneous ventricular fibrillation in four of ten dogs with H76, compared with two of ten with HB, and zero of ten with OM (P = .07). The induction of two premature beats by programmed stimulation of the myocardium during injection of 4 mL of contrast medium produced ventricular fibrillation in ten of ten dogs with H76, compared with three of ten with HB, and zero of ten with OM (P less than .001). Both H76 and HB produced ventricular fibrillation in ten of ten dogs when three premature beats were induced, compared with two of ten dogs with OM (P less than .001). Four mL H76 produced a 109 +/- 18 msec increase in the QT interval, compared with an 82 +/- 17 msec increase with HB, and a 45 +/- 12 msec increase with OM. We conclude that both low osmolar HB and OM are less fibrillatory than the conventional ionic medium H76, and that the nonionic medium OM is less fibrillatory than the ionic dimer contrast medium HB.