Reduced human ventricular fibrillation threshold associated with contrast-induced Q-T prolongation

Injection of contrast dye during selective coronary arteriography prolongs the Q-T interval well beyond that expected for the accompanying bradycardia. A case is presented in which a 5 mA stimulus delivered prematurely by an improperly sensing ventricular demand pacemaker initiated ventricular fibrillation during coronary arteriography, although no evidence of coronary or other cardiac disease was found. An analysis is made of the progressive Q-T and T changes following contrast dye injection, and their relation to the onset of ventricular fibrillation. The implications of these observations are discussed in light of existing data on human ventricular vulnerability.