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Ventricular fibrillation during coronary angiography: reduced incidence in man with contrast media lacking calcium
Insights
Using Angiovist 370 (AV370), a contrast medium without sodium citrate and EDTA, significantly reduced ventricular fibrillation during coronary angiography compared to Renografin 76 (RG76). This finding offers a safer contrast agent for cardiac procedures.
Area of Science:
- Cardiology
- Medical Imaging
- Pharmacology
Background:
- Intracoronary injection of contrast media during coronary angiography can trigger ventricular fibrillation.
- Experimental studies suggest sodium citrate and EDTA in Renografin 76 (RG76) contribute to this complication.
Purpose of the Study:
- To compare the incidence of contrast media-induced ventricular fibrillation between RG76 and Angiovist 370 (AV370).
- To determine if AV370, lacking sodium citrate and EDTA, reduces ventricular fibrillation during coronary angiography.
Main Methods:
- A comparative study involving 2,500 patients receiving RG76 (Group A) and 2,000 patients receiving AV370 (Group B).
- Patient demographics and clinical characteristics were similar between groups.
- Incidence of contrast media-induced ventricular fibrillation was recorded for both groups.
Main Results:
- Fifteen episodes of ventricular fibrillation occurred in Group A (0.6% incidence) versus two episodes in Group B (0.1% incidence).
- The difference in incidence was statistically significant (p < 0.02).
- All patients were successfully defibrillated without adverse sequelae.
Conclusions:
- Contrast media lacking sodium citrate and EDTA, such as AV370, significantly decrease the incidence of ventricular fibrillation during coronary angiography.
- AV370 represents a safer alternative contrast agent for cardiac procedures.
Abstract:
The intracoronary injection of contrast media during coronary angiography occasionally results in ventricular fibrillation. Experimental studies have implicated the calcium sequestering agents, sodium citrate and EDTA in Renografin 76 (RG76), as contributing to this complication. Angiovist 370 (AV370) is a contrast medium similar to RG76 except that it contains disodium calcium EDTA instead of EDTA and sodium citrate. To determine if contrast media lacking sodium citrate and EDTA will result in a lower incidence of ventricular fibrillation in man, this investigation compared the incidence of contrast media-induced ventricular fibrillation in patients undergoing coronary angiography with RG76 to that with AV370. Group A consisted of 2,500 consecutive patients undergoing coronary angiography with RG76 and group B consisted of 2,000 subsequent consecutive patients in whom AV370 was employed as the contrast medium. There was no significant difference between groups A and B with respect to the volume of contrast media used per patient (153 +/- 49 ml vs 154 +/- 45ml), age (58.4 +/- 10 vs 58.6 +/- 10 years), sex (70% male vs 70% male), ejection fraction (59 +/- 17 vs 60 +/- 20), history of mitral valve disease (5.8% vs 7.1%), history of aortic valve disease (6.7% vs 6.5%), prior coronary artery bypass graft surgery (6.6% vs 7.3%), or extent of coronary artery disease. Fifteen episodes of contrast media-induced ventricular fibrillation occurred in group A (incidence 0.6%) whereas two episodes occurred in group B (incidence 0.1%) (p less than 0.02). Each patient was successfully defibrillated and no adverse sequelae resulted. Thus the present investigation suggests that the incidence of ventricular fibrillation during coronary angiography can be significantly decreased by using contrast media lacking sodium citrate and EDTA.