THE ROLE OF SODIUM IN PROMOTING VENTRICULAR ARRHYTHMIA DURING SELECTIVE CORONARY ARTERIOGRAPHY

Abstract

Conclusions have been drawn in past experimentation that myocardial toxicity of contrast media during selective cardiac vessel studies is related to high sodium ion concentration and/or the prophylactic effect of methylglucamine salts. This paper evaluates the incidence of cardiac arrhythmias during human and canine selective coronary arteriography using 2 formulations of renografin 76 per cent which have sodium concentrations of approximately 0.19 mEq./ml. and 0.04 mEq./ml. Five marked ventricular arrhythmias associated with contrast agent were noted in 79 selective coronary artery injections in 30 patients for an incidence of 6.3 per cent. Only one of these—a transient asystole— followed the use of an agent with the higher sodium content. Nineteen randomized selective coronary arteriography studies in dogs produced 9 cases of ventricular fibrillation. All fibrillations occurred during right coronary artery injection, and all but 1 occurred while using the agent with the lower sodium content. Thus, a purer form of methylglucamine diatrizoate leads to a significantly higher incidence of ventricular fibrillation than with the less pure form in selective coronary arteriography.