Clinical Efficacy of Intracoronary Papaverine After Nicorandil Administration for Safe and Optimal Fractional Flow Reserve Measurement

Fractional flow reserve (FFR) is considered the standard for assessment of physiological significance coronary artery stenosis. Intracoronary papaverine (PAP) most potent vasodilator used achievement maximal hyperemia. However, its use can provoke ventricular tachycardia (VT) due to excessive QT prolongation. We evaluated clinical efficacy and safety administration PAP after nicorandil (NIC), a potassium channel opener that prevents VT, optimal FFR measurement.A total 127 patients with 178 stenoses were enrolled. The values measured using NIC (NIC-FFR) (PAP-FFR). administered following (NIC-PAP). Changes in electrogram parameters (baseline versus PAP) assessed incidence arrhythmias was evaluated. In addition, we analyzed another 41 51 by assessing before (PAP-NIC). After propensity score matching, between 2 groups compared.The mean PAP-FFR significantly lower than NIC-FFR (0.82 ± 0.11 0.81 0.11, P < 0.05). baseline-QTc, NIC-QTc, PAP-QTc 425 37 ms1/2, 424 483 54 respectively. VT occurred only 1 patient (0.6%). Although induced QTc prolongation (P 0.05), duration shorter NIC-PAP compared PAP-NIC 0.05).The may induce sufficient hyperemia prevent fatal arrhythmia through reductions PAP-induced during measurement.