Torsades de pointes after intracoronary papaverine |
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Authors: | M Vrolix J Piessens H De Geest |
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Affiliation: | Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium. |
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Abstract: | 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. |
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Keywords: | Intracoronary Doppler papaverine ventricular arrhythmia |
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