BRIEF RESEARCH REPORT article
Front. Cardiovasc. Med.
Sec. Coronary Artery Disease
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1621053
This article is part of the Research TopicNew Concepts in Revascularization Strategies and Antithrombotic Therapies in Patients With Non-ST Elevated Acute Coronary SyndromesView all 4 articles
Arrhythmia Prevention Protocol During Papaverine Administration for Invasive Coronary Functional Assessment
Provisionally accepted
Dobrin Vassilev1,2*
Niya Mileva2
Gavril Stoev2Ilter Pazardzhykly2Panayot Panayotov2Gianluca Rigatelli3Valery Gelev4- 1University of Ruse, Ruse, Bulgaria, Bulgaria
- 2SHATC Medica Cor, Ruse, Bulgaria
- 3Ospedali Riuniti Padova Sud, Padova, Italy
- 4Acibadem City Clinic, Tokuda Hospital, Cardiology Clinic, Sofia, Bulgaria
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Background Accurate assessment of coronary physiology through invasive functional testing is critical for managing chronic coronary syndromes. Induction of maximal and sustained coronary hyperemia is essential for reliable measurements of fractional flow reserve (FFR), coronary flow reserve (CFR), and index of microcirculatory resistance (IMR). Intracoronary papaverine is a highly effective vasodilator for inducing hyperemia but has been associated with ventricular arrhythmias, limiting its clinical use. Methods This is a single-center prospective study investigating the feasibility and safety of a novel hyperemia protocol involving intravenous lidocaine administration followed by intracoronary papaverine in patients undergoing invasive coronary functional assessment. All patients underwent FFR, CFR, and IMR measurements after receiving initial dose of 100 mg of i.v. lidocaine followed by papaverine (20 mg for the left and 5–10 mg for the right coronary artery). Results A total of 389 patients were enrolled. Functionally significant stenosis (FFR ≤ 0.80) was identified in 36% of patients, and microvascular dysfunction in 48%. Ventricular arrhythmias occurred in 1.5% of patients, including four episodes of ventricular fibrillation and two of ventricular tachycardia; all resolved with prompt defibrillation and without hemodynamic compromise. Conclusion These findings suggest that pre-treatment with lidocaine may enhance the safety of papaverine-induced hyperemia during invasive coronary testing
Keywords: arrhythmia, functional assessment, Fractional flow reserve, Chronic coronary syndrome (CCS), Hyperemia
Received: 30 Apr 2025; Accepted: 18 Aug 2025.
Copyright: © 2025 Vassilev, Mileva, Stoev, Pazardzhykly, Panayotov, Rigatelli and Gelev. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Dobrin Vassilev, University of Ruse, Ruse, Bulgaria, Bulgaria
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