Torsades de pointes after intracoronary papaverine.
Coronary blood flow velocity and coronary flow reserve can be assessed in humans using a coronary Doppler catheter and the vasodilator papaverine. Although it is a safe, elegant and reproducible technique, serious complications can occur. Coronary flow reserve assessment in a 49-year-old man with a critical stenosis in the proximal part of the circumflex artery was complicated by a papaverine-induced ventricular arrhythmia. Several features of the present case report support papaverine-induced disturbances of the repolarization phase as the pathophysiological mechanism: a 'torsade de pointes' pattern of the tachycardia, the lengthening of the QT-interval, the appearance of a new U-wave and the presence of additional risk factors (hypokalaemia and alcalosis). Patients presenting additional risk factors for this complication should be excluded from coronary flow reserve assessment.
Vrolix
M
M
Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium.
Piessens
J
J
De Geest
H
H
D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D001783:Blood Flow Velocity / Q000187:drug effects / Q000502:physiology; D003326:Coronary Circulation / Q000187:drug effects / Q000502:physiology; D003327:Coronary Disease / Q000503:physiopathology / Q000628:therapy*; D004562:Electrocardiography / Q000187:drug effects*; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D008981:Molsidomine / Q000008:administration & dosage / Q000031:analogs & derivatives; D010208:Papaverine / Q000008:administration & dosage / Q000009:adverse effects*; D016171:Torsades de Pointes / Q000139:chemically induced*; D014665:Vasodilator Agents
D014665:Vasodilator Agents; C002385:linsidomine; D008981:Molsidomine; D010208:Papaverine