Korean Circ J.  2009 Jun;39(6):223-227. 10.4070/kcj.2009.39.6.223.

Alteration of Ventricular Repolarization by Intracoronary Infusion of Normal Saline in Patients With Variant Angina

• Kim JK
• Kim NH
• Shin IS
• Noh DH
• Kim YC
• Kim SH
• Choi JH
• Park EM
• Lee SJ
• Yun KH
• Yoo NJ
• Lee EM
• Oh SK
• Jeong JW

• KMID: 1490697
• DOI: http://doi.org/10.4070/kcj.2009.39.6.223

Abstract

BACKGROUND AND OBJECTIVES: During coronary angiography and interventional procedures, catheters that are engaged in a coronary ostium are routinely flushed, typically with normal saline, to expel blood from the catheter or to inject a pharmacologic agent. Saline contains sodium and chloride ions. Such injections may affect the electrophysiologic properties of the myocardium; however, the effect of normal saline on ventricular repolarization has not been established in patients with variant angina.
SUBJECTS AND METHODS
We studied 51 consecutive patients with variant angina. Five mL of normal saline (NS) or 5% dextrose solution (DW) were infused into the left coronary artery in random order. We measured the heart rate, QT interval, and T-wave amplitude using Mac-Lac 5.2.
RESULTS
The baseline clinical characteristics were not different between the NS {n=30 (14 males); mean age, 56+/-10 years} and the 5% DW groups {n=21 (7 males); mean age, 59+/-10 years}. The changes in the mean corrected QT (QTc) interval were significantly increased at the time of infusion of NS compared to 5% DW (45.1+/-30.3 vs. 20.9+/-23.3 ms, p=0.004). There was a T-wave amplitude change >0.2 mV in at least one-lead in 27 patients (90.0%) during NS infusion compared to 7 patients (33.3%) during 5% DW infusions (p=0.001). No significant changes in heart rate and blood pressure were noted during of the infusions.
CONCLUSION
NS was associated with prolongation of ventricular repolarization in patients with variant angina.

Keyword

Angiography; Sodium chloride; Angina pectoris, variant; Arrhytromia, cardiac

MeSH Terms

Angina Pectoris, Variant
Angiography
Blood Pressure
Catheters
Coronary Angiography
Coronary Vessels
Glucose
Heart Rate
Humans
Ions
Sodium
Sodium Chloride
Glucose
Ions
Sodium
Sodium Chloride

Figure

• 

  Fig. 1 A representative measurement of the QT interval and T amplitude using Mac-Lab 5.2. The QT interval was 395 ms and T amplitude was 0.55 mV with a speed of 100 mm/sec in lead III.

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  Fig. 2 Comparison of the mean QTc interval after intracoronary injection. NS: normal saline, DW: dextrose water, QTc: corrected QT interval by Bazett's formula.

• 

  Fig. 3 ECGs recorded during intracoronary injection in a single patient. Note the marked changes in T-waves (arrow) and QT duration during and immediately after intracoronary normal saline injection (A). In contrast, T-waves and QT intervals remain stable during intracoronary 5% dextrose water injection (B). ECG: electrocardiogram.

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  Fig. 4 Percentage of patients with ST and T-wave changes in at least one lead during and immediately after intracoronary injections. NS: normal saline, DW: dextrose water.

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