Abstract P239: Papaverine-induced Ventricular Fibrillation Developing During Coronary Flow Reserve Studies

Abstract

Background: Estimation of the fractional flow reserve (FFR) is considered to be an established method by which to assess stable coronary artery stenosis. Induction of maximal coronary hyperemia is important during FFR. Papaverine is often used to achieve maximal hyperemia. However, this drug has been reported to increase the risk of ventricular arrhythmias. The purpose of the present study was to discover predictors of papaverine-induced ventricular fibrillation (VF) developing during FFR. Methods: A total of 187 clinically stable patients were included in the study. FFR was performed to evaluate lesions for which percutaneous coronary intervention (PCI) was to be considered after coronary angiography. FFRs were determined after intracoronary papaverine administration (12 mg into the left and 8 mg into the right coronary arteries). We compared patients in whom VF did and did not develop in terms of clinical and ECG characteristics. Results: We performed FFR on 214 lesions (112 in the left anterior descending arteries, 38 in the left circumflex arteries, and 64 in the right coronary arteries) of 187 patients. The average patient age was 72.5 ± 10 years. We found that the QTc interval was prolonged in all patients after papaverine administration (average post-administration QTc interval = 569 ± 89 ms; average ΔQTc interval = 144 ± 80 ms). VF developed in three patients with significantly prolonged QT intervals (average post-administration QTc interval = 639 ± 19 ms, average ΔQTc interval = 220 ± 64 ms, p < 0.02) and all of them occurred after administration of papaverine into the left coronary artery. Three-vessel disease was significantly predictive of VF (p < 0.003). In the three-vessel group, the complications of low left ventricular function (ejection fraction<50%), hypokalemia (serum K <3.5 mEp/L), and bradycardia (<50 beats/min), were significantly associated with VF (p < 0.045). Conclusions: Three-vessel disease is a predictor of the development of VF during FFR performed with the aid of papaverine, especially if accompanied by one or more of low left ventricular function, hypokalemia, or bradycardia.