Influence of low osmolality contrast media on electrophysiology and hemodynamics in coronary angiography: Differences between an ionic (loxaglate) and a nonionic (lohexol) agent

Abstract

It has recently been suggested that the addition of sodium to low osmolality contrast media may reduce the incidence of ventricular fibrillation and conduction disturbances during coronary angiography. In a randomized, double blind study of 30 patients undergoing coronary angiography we therefore examined the electrophysiological and hemodynamic effects of the two low osmolality contrast media-ioxaglate (with sodium) and iohexol (without sodium). Standard ECG, aortic blood pressure, and His bundle electrocardiogram were recorded. The contrast media were well tolerated and no serious arrhythmias were observed. Both induced a transient decrement in systolic blood pressure and reduction in heart rate 10 s following contrast injection (all P less than 0.01). Ioxaglate prolonged the QT interval at 10 s (P less than 0.01) and also when analysed for the whole observation period (120 s) (P less than 0.05), whereas iohexol did not cause any significant changes in the QT-interval. The AH-interval was prolonged by ioxaglate at 10 s (P less than 0.01), but not altered by iohexol. Thus, other factors than osmolality and sodium content might contribute to QT prolongation, since only the contrast agents with sodium (ioxaglate) induced QT prolongation in this study.

Addition of Sodium to the Nonionic Contrast Medium Iohexol during Coronary Angiography in Man

“…The small but significant changes observed in QT interval, QRS duration, and systolic blood pressure 10 s after injection of contrast medium by both media are of similar magnitude and direction for both preparations, and confirm previous studies with iohexol (24).…”