Abstract
Electrophysiological (EP) evaluation in children is performed before or after angiography in several centers. Since contrast medium is known to depress contractility and to prolong the QT interval, a prospective study was designed to compare the effects of angiography on EP studies. Eleven children with various congenital heart defects, ages 2-18 yrs, and free of arrhythmias were evaluated by programmed atrial stimulation. EP evaluation consisted of determining SNRT, Wenckebach periodicity and refractory periods before and after angiography at comparable cycle lengths. In 5/11 (45%) Wenckebach periodicity was observed at longer cycle lengths after angiography. In 6/11 (55%) the atrial effective refractory period shortened after angiography, prolonged in 1/11 (9%) and did not change in 4/11 (36%). The atrial functional refractory period shortened after angiography in 5/11 (45%), lengthened in 4/11 (36%) and did not change in 2/11 (18%). Atrioventricular nodal refractory period determination was limited by atrial refractoriness. No significant change was noted in SNRT. Cardiac angiography depresses atrioventricular nodal function as evaluated by Wenckebach periodicity, had no effect on sinus node function and shortened atrial refractory periods. Therefore, electro-physiological evaluation in children should be performed prior to cardiac angiography.
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