Programmed left ventricular contrast injection. A method to minimize left ventricular irritability during angiography

Left ventricular angiography frequently produces one or more premature atrial or ventricular contractions which may make quantitative volume analysis unreliable. Three hundred left ventricular power injections were analyzed and found to produce premature ventricular contractions (PVC's) in 28 per cent of injections and PAC's in 6 per cent. Forty-four per cent of injections starting near the end of the T wave were associated with PVC's, whereas those starting near the end of diastole during the P wave produced PVC's in only 11 per cent. Injections through a Gensini catheter were associated with PVC's in 24 per cent compared to 37 per cent when a pigtail catheter was used (p less than 0.05). The introduction of an 0.6 second delay in the development of peak injection pressures and ECG triggering to start the injection in the last half of the cardiac cycle did not alter the incidence of PVC's. The use of timed diastolic injections with pressure rate-rise delay is of little value in reducing injection induced arrhythmias.