Aggravation of pre-existing atrioventricular block, Wenckebach type, provoked by application of X-ray contrast medium.
BACKGROUND
Significant bradycardia followed by cardiac arrest related to single bolus administration of X-ray contrast medium into a peripheral artery has not, to our knowledge, been described in the literature.


RESULTS
While performing a percutaneous transluminal angioplasty of the left superficial femoral artery in a 68-year old patient with a pre-existing atrioventricular (AV) block, Wenckebach type, he developed an AV block III after a single bolus injection of intra-arterial X-ray contrast medium.


CONCLUSIONS
We believe that application of contrast medium causes a transitory ischemia in the obstructed vessel and therefore elevation of endogenous adenosine. In the case of a previously damaged AV node this elevation of endogenous adenosine may be responsible for the development of a short period of third-degree AV block.
Brodmann
Marianne
M
Division of Angiology, Department of Internal Medicine, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Austria. marianne.brodmann@meduni-graz.at
Seinost
Gerald
G
Stark
Gerhard
G
Pilger
Ernst
E
D000368:Aged; D000792:Angiography / Q000379:methods*; D000800:Angioplasty, Balloon / Q000379:methods; D001157:Arterial Occlusive Diseases / Q000628:therapy; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D018450:Disease Progression; D004562:Electrocardiography; D005263:Femoral Artery / Q000601:surgery; D006327:Heart Block / Q000139:chemically induced* / Q000503:physiopathology*; D006801:Humans; D007431:Intraoperative Complications / Q000139:chemically induced / Q000473:pathology; D008297:Male; D012720:Severity of Illness Index
D003287:Contrast Media