title: Intracoronary adenosine-induced ventricular arrhythmias during fractional flow reserve (FFR) measurement: case series and literature review.
abstract: Fractional flow reserve (FFR) is a standardized and well-established method frequently used in clinical practice to evaluate the hemodynamic significance of epicardial coronary stenosis identified by coronary angiography. It is based on the change in the pressure gradient across the stenosis after the achievement of maximal hyperemia of the coronary circulation which is commonly induced by intravenous (IV) or intracoronary (IC) administration of adenosine. Here, we have described three cases of IC adenosine-induced ventricular arrhythmias during FFR measurement from our institution, and after literature review we found that all the cases of ventricular arrhythmias induced by adenosine during FFR measurement were observed where it was administered via IC route. Although a causal relationship between the use of IC adenosine during FFR measurement and the induction of ventricular arrhythmias is not yet established, we suggest using IV adenosine as the preferred route of administration until we better understand the incidence and mechanism underlying this phenomenon.
authors: Division of Cardiology, Department of Medicine, New York Medical College, Saint Joseph's Regional Medical Center, 703 Main St., Paterson, NJ, 07503, USA. hiten0409@yahoo.com.
authors: Hiten R
authors: http://orcid.org/0000-0002-0921-1029
authors: HR
authors: Patel
authors: Division of Cardiology, Department of Medicine, New York Medical College, Saint Joseph's Regional Medical Center, 703 Main St., Paterson, NJ, 07503, USA.
authors: Priyank
authors: P
authors: Shah
authors: Division of Cardiology, Department of Medicine, New York Medical College, Saint Joseph's Regional Medical Center, 703 Main St., Paterson, NJ, 07503, USA.
authors: Sharad
authors: S
authors: Bajaj
authors: Division of Cardiology, Department of Medicine, New York Medical College, Saint Joseph's Regional Medical Center, 703 Main St., Paterson, NJ, 07503, USA.
authors: Hartaj
authors: H
authors: Virk
authors: Division of Cardiology, Department of Medicine, New York Medical College, Saint Joseph's Regional Medical Center, 703 Main St., Paterson, NJ, 07503, USA.
authors: Mahesh
authors: M
authors: Bikkina
authors: Division of Cardiology, Department of Medicine, New York Medical College, Saint Joseph's Regional Medical Center, 703 Main St., Paterson, NJ, 07503, USA.
authors: Fayez
authors: F
authors: Shamoon
mesh_terms: D000241:Adenosine / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000139:chemically induced* / Q000628:therapy; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000187:drug effects; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D003331:Coronary Vessels / Q000187:drug effects; D004554:Electric Countershock; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006352:Heart Ventricles / Q000187:drug effects; D006801:Humans; D006940:Hyperemia / Q000139:chemically induced; D007261:Infusions, Intra-Arterial / Q000009:adverse effects*; D007262:Infusions, Intravenous; D008875:Middle Aged; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine
keywords: Adenosine; FFR; Fractional flow reserve; Intracoronary; Ventricular fibrillation; Ventricular tachycardia