Ventricular arrhythmia due to intracoronary papaverine: Analysis of QT intervals and coronary vasodilatory reserve

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Abstract
Intracoronary papaverine commonly produces striking QT interval prolongation with rare but serious ventricular dysrhythmias reported. Because of 3 cases of severe papaverineinduced dysrhythmia in our laboratory, QT intervals and hemodynamic and intracoronary velocity data collected during intracoronary papaverine administration were retrospectively reviewed in 34 patients; 20 patients with angiographically normal coronary arteries (group 1) and 14 patients (group 2) before and (group 2) after single‐vessel left coronary angioplasty. QT intervals increased from 394 ± 44 to 464 ± 73 msec, 414 ± 47 to 504 ± 95 msec, and 410 ± 41 to 486 ± 75 msec for groups 1 and 2 before and after angioplasty, respectively (all P < 0.01). There was no correlation with hemodynamic, electrocardiographic, or coronary vasodilatory reserve responses and change in QTc interval. In the 3 index patients having significant papaverine‐related arrhythmias, a baseline QT interval was prolonged (after prior papaverine exposure) in only 1 in association with trosade de pointes. These data indicate that QT interval prolongation after papaverine is a common occurrence, but that the production of ventricular dysrhythmia is probably idiosynchratic in origin. In view of these findings, we recommend that appropriate antiarrhythmic preparations be in place for patients receiving intracoronary papaverine.