Contrast-medium-induced ventricular fibrillation: arrhythmogenic mechanisms and the role of antiarrhythmic drugs in dogs

Academic Radiology
H K PedersenH Refsum

Abstract

Small electrolyte additions to a nonionic contrast medium reduce the risk of ventricular fibrillation (VF) during wedged catheter injection of a contrast medium. The current study was designed to further investigate contrast-medium-induced VF by studying the effect of pretreatment with different antiarrhythmic drugs. During a simulated wedged catheter situation, iohexol was injected into the anterior descending branch of the left coronary artery in five open-chest, anesthetized dogs pretreated with lidocaine, propranolol, amiodarone, almokalant, or verapamil. Wedging the catheter for 60 sec did not induce VF. However, all 15 wedged catheter injections with iohexol induced VF within 28 sec (19 +/- 1 [mean +/- standard error of the mean]) despite pretreatment with antiarrhythmic drugs. Prior to VF, conduction was slowed and monophasic action potential duration lengthened in the contrast-medium-perfused myocardium, although no significant changes occurred in the control area. The combination of catheter wedging and long-lasting contrast medium injection has a high risk of causing VF. Although adding a small amount of electrolytes to nonionic contrast media can reduce the risk of VF, antiarrhythmic drug therapy may not have a prote...Continue Reading

References

Sep 1, 1988·Investigative Radiology·W H RalstonR M Hopkins
Sep 1, 1988·Investigative Radiology·K Hayakawa, K Yamashita
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Citations

Feb 6, 1999·European Journal of Radiology·S K MorcosJ O Karlsson
Jul 7, 2009·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Peter BarlisEvelyn Regar
Mar 21, 2009·Expert Review of Medical Devices·Peter BarlisEvelyn Regar
Feb 14, 2007·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Joel A GarciaJohn D Carroll
Aug 26, 2021·Clinical Case Reports·Ourania KarikiVassilis Voudris

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