urografin-76 and Arrhythmias--Cardiac

The hemodynamic and electrophysiologic alterations induced by ionic contrast agents during cardiac angiography are well described. Recently nonionic contrast agents have become available for cardiac angiography. To evaluate the safety of these new agents, a double-blind randomized study was performed comparing a new nonionic agent (iopamidol) with a commonly used ionic contrast agent (Renografin-76). Eighty-one patients undergoing left ventriculography and coronary angiography were included; 41 received iopamidol and 40 received sodium meglumine diatrizoate (Renografin-76). After left ventriculography, there was a decrease in the arterial pressure with both contrast agents. However, the severity and the duration of hypotension were both significantly greater with Renografin-76 compared with the new nonionic agent (p less than 0.001). After selective injections of the coronary arteries, electrocardiographic analysis demonstrated that the increase in the QT interval (p less than 0.0002) and the changes in both the ST segment and T wave amplitude (p less than 0.001) were significantly greater in the Renografin-76 group compared with the iopamidol group. During coronary angiography, 8 of the 40 patients receiving Renografin-76 required temporary pacing for sinus pauses of 2.5 seconds or more, and 2 of the 40 also developed ventricular fibrillation. None of the 41 patients receiving iopamidol had these complications. This report demonstrates that the electrocardiographic changes, the severity and duration of hypotension and the incidence of serious arrhythmias are significantly greater with Renografin-76 than with iopamidol. Thus, this new nonionic agent appears to enhance the safety of cardiac angiography.

Topics: Aged; Angiocardiography; Arrhythmias, Cardiac; Clinical Trials as Topic; Contrast Media; Coronary Disease; Diatrizoate; Diatrizoate Meglumine; Double-Blind Method; Drug Combinations; Electrocardiography; Heart Valve Diseases; Hemodynamics; Humans; Iopamidol; Iothalamic Acid; Male; Middle Aged; Pain; Random Allocation; Thorax

Contrast media occasionally produce bradyarrhythmias defined as a 25% decrease in heart rate and/or developing atrioventricular block during coronary angiography. Twelve left coronary angiographies and seven right coronary angiographies were performed with 10 ml of diatrizoate meglumine and diatrizoate sodium (Renografin-76 [R76] or Hypaque [H76]) or iopamidol (Isovue 370 [ISO]) in a blinded randomized fashion. Heart rate decreased significantly from 135 +/- 5 to 120 +/- 5 beats/min (p less than 0.001) with R76, to 127 +/- 7 beats/min (p less than 0.01) with H76, and to 130 +/- 6 beats/min (p less than 0.05) with ISO in left coronary angiographies; more profound decrease was observed in right coronary angiographies from 134 +/- 4 to 87 +/- 18 beats/min (p less than 0.001) with R76, to 99 +/- 14 beats/min (p less than 0.001) with H76, and to 125 +/- 7 beats/min (p less than 0.01) with ISO. In 12 left coronary angiographies bradyarrhythmia was observed in five cases with R76, two with H76, and none with ISO. In seven right coronary angiographies it occurred in six with R76, three with H76, and none with ISO. The differences in the incidence of bradyarrhythmia between R76 and ISO were significant during left and right coronary angiographies (p less than 0.05 and p less than 0.01, respectively). Thus ionic contrast media produced more marked bradyarrhythmias than nonionic contrast media in coronary angiography, especially R76. Right coronary angiography resulted in more profound bradyarrhythmias than left coronary angiographies. This study suggested that nonionic contrast media (ISO) might be preferable to ionic contrast media (R76 or H76) for coronary arteriography.

Topics: Angiography; Animals; Arrhythmias, Cardiac; Bradycardia; Contrast Media; Coronary Angiography; Diatrizoate; Diatrizoate Meglumine; Dogs; Drug Combinations; Female; Heart Rate; Incidence; Iopamidol; Male

Sequential measurement of QT interval during left ventricular angiography was made 30 seconds and one, three, five and ten minutes after injection of hypaque 76. The subjects were ten patients found to have normal left ventricles and coronary arteries. Significant QTC prolongation occurred in 30 seconds to one minute in association with marked hypotension and elevation of cardiac output.

Topics: Arrhythmias, Cardiac; Contrast Media; Coronary Disease; Diatrizoate; Diatrizoate Meglumine; Drug Combinations; Electrocardiography; Heart Ventricles; Humans; Radiography; Risk; Ventricular Fibrillation

A low but significant fatality rate persists in intravenous urography. Fatalities are sudden and their cause is not understood. This trial assessed the arrhythmogenic effects of a common urographic contrast agent. Using standard bolus injection techniques, 12 patients out of 58 (20%) developed post-injection arrhythmias. Seven of these cases (12%) were considered to have significant or potentially serious arrhythmias. This group includes various paroxysmal tachycardias and a case of atrioventricular block. Arrhythmia post-injection was commoner in the male and in the older age groups. An abnormal control ECG was not found to be a predisposing factor to the development of arrhythmia. It is suggested that the findings reflect the high incidence of latent coronary heart disease in our older male population. No correlation was found with minor side-effects of contrast injection and the development of arrhythmia.

Topics: Adolescent; Adult; Age Factors; Aged; Arrhythmias, Cardiac; Diatrizoate; Diatrizoate Meglumine; Drug Combinations; Electrocardiography; Female; Humans; Male; Middle Aged; Sex Factors; Urography