Predictive factors and mechanism of arrhythmias and myocardial ischaemic changes in elderly patients during barium enema

The incidence of significant arrhythmias and ST segment changes during barium enema examination (BE) was evaluated by Holter monitoring of 58 unselected patients over the age of 60 years. Forty percent of the group developed new significant arrhythmias of which the most common were frequent and/or multifocal premature ventricular contractions. Seven percent demonstrated ST segment depression. Administration of glucagon did not diminish the incidence of arrhythmias. Predictive factors for ECG abnormalities were advancing age, abnormal pre BE ECG, and pre BE orthostatic hypotension. Analysis of arrhythmias and response to physiologic manoeuvres suggested that the abnormalities were related to increased sympathetic tone which may be intensified by hypovolaemia resulting from routine bowel preparation.