title: Papaverine-induced polymorphic ventricular tachycardia in relation to QTU and giant T-U waves in four cases.
abstract: OBJECTIVE
  Papaverine is used for the evaluation of functional status of the coronary arteries but it may provoke severe ventricular tachyarrhythmias (VTAs). This study compared the clinical and ECG characteristic of patients with papaverine-induced VTAs.
  
  
  METHODS
  The study involved 25 patients who underwent a fractional flow reserve (FFR) study. FFR was determined as the ratio of blood pressure at the distal and the proximal site of stenosis after intracoronary papaverine administration at 12 mg into the left and 8 mg into the right coronary artery. The QT and QTU intervals were measured manually in the limb leads and in the precordial leads, respectively and corrected by the R-R interval to obtain QTc and QTUc. The clinical and ECG data were compared between the patient groups with and without VTAs.
  
  
  RESULTS
  After papaverine administration into the left (20), right (3) or both coronary arteries (2), the RR interval shortened, but non-significantly however, the QT interval (and QTc) and the QTU interval (and QTUc) were significantly prolonged. VTAs developed in four women: torsade de pointes in 3 followed by ventricular fibrillation and ventricular premature beats in 1 patient. After papaverine administration, QTU and QTUc were more prolonged in women than men and in patients with VTAs compared to those without. Just prior to VTAs, giant T-U waves were observed.
  
  
  CONCLUSIONS
  Intracoronary papaverine was used to determine FFR which may induce VTAs. VTAs developed only in women and they were closely related to prolongation of the QTU intervals with prominent T-U waves.
authors.affiliation: Cardiovascular Center, Tachikawa General Hospital, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Nakayama
authors.forename: Atsushi
authors.initials: A
authors.lastname: Saito
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kitazawa
authors.forename: Minoru
authors.initials: M
authors.lastname: Takahashi
authors.forename: Masahito
authors.initials: M
authors.lastname: Sato
authors.forename: Koichi
authors.initials: K
authors.lastname: Fuse
authors.forename: Masaaki
authors.initials: M
authors.lastname: Okabe
authors.forename: Kou
authors.initials: K
authors.lastname: Hoshino
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Tanaka
authors.forename: Akira
authors.initials: A
authors.lastname: Yamashina
authors.forename: Yoshifusa
authors.initials: Y
authors.lastname: Aizawa
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000150:complications / Q000503:physiopathology*; D003331:Coronary Vessels / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D008875:Middle Aged; D010208:Papaverine / Q000494:pharmacology*; D017180:Tachycardia, Ventricular / Q000139:chemically induced* / Q000503:physiopathology
chemical_list: D010208:Papaverine