Ventricular fibrillation during coronary angiography: Reduced incidence with nonionic contrast media

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Abstract
Ventricular fibrillation during coronary angiography with Renografin-76 has been attributed to the high osmolar ionic and calcium binding additive properties. Isovue-370 is a new low osmolar nonionic contrast medium lacking calcium binding additives. The present investigation compared the incidence of contrast media-induced ventricular fibrillation in patients undergoing coronary angiography with Renografin-76 to that with Isovue-370. Group I consisted of 2,000 consecutive patients undergoing coronary angiography with Renografin-76, and group II consisted of 2,000 subsequent consecutive patients in whom lsovue-370 was employed as the contrast medium. There was no significant difference between groups I and II with respect to volume of contrast media used per patient (125 ± 35 vs. 140 ± 45 ml), age (63.5 ± 15 vs. 60 ± 17 years), sex (74% male vs. 76% male), ejection fraction (55% vs. 55%), valvular heart disease (8% vs. 9%), prior coronary artery bypass graft surgery (5.8% vs. 5%), or extent of coronary artery disease. Contrast media-induced ventricular fibrillation occurred in 20 patients in group I (incidence 1%), whereas eight episodes occurred in group II (incidence 0.4%) (P < 0.03). Thus the present investigation suggests that the incidence of ventricular fibrillation during coronary angiography can be significantly decreased by using low osmolar nonionic contrast media lacking calcium binding additives.