Torsade de pointes induced by ioxaglate intracoronary injection in patients with pre-existent drug-induced QT prolongation: case reports and review of literature.
We report two cases of torsade de pointes directly related to intracoronary contrast media injection in patients without previous history of neither arrhythmia nor syncope but chronically treated with a drug prolonging ventricular repolarization. We discussed the effects of the contrast medium used on repolarization and concluded that three suggestions may be highlighted from the case reports presented and from the literature: (i) a QT prolongation should be systematically searched before coronary angiography; (ii) it seems important to correct QT prolongation when it results from a reversible cause (such as drug-induced) before nonurgent coronary angiography; and (iii) if there is no reversible cause explaining QT prolongation, contrast media should be used cautiously in such patient and nonionic iso-osmolar contrast media should be preferred.
Andréjak
Michel
M
Regional Centre of Pharmacovigilance CHU, Amiens, France. andrejak.michel@chu-amiens.fr
Leborgne
Laurent
L
Tribouilloy
Christophe
C
Andréjak
Marie-thérèse
MT
Caron
Jacques
J
D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D017023:Coronary Angiography / Q000379:methods; D006801:Humans; D007485:Ioxaglic Acid / Q000008:administration & dosage / Q000009:adverse effects*; D008133:Long QT Syndrome / Q000139:chemically induced* / Q000150:complications; D008297:Male; D008875:Middle Aged; D016171:Torsades de Pointes / Q000139:chemically induced* / Q000150:complications
D003287:Contrast Media; D007485:Ioxaglic Acid