{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T09:33:38Z","timestamp":1758188018878,"version":"3.44.0"},"reference-count":10,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T00:00:00Z","timestamp":1758153600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Accurate assessment of coronary physiology through invasive functional testing is critical for the effective management of chronic coronary syndromes. The induction of maximal and sustained coronary hyperemia is essential for obtaining reliable measurements of fractional flow reserve (FFR), coronary flow reserve (CFR), and the index of microcirculatory resistance (IMR). Intracoronary papaverine is a potent vasodilator for inducing hyperemia but has been associated with ventricular arrhythmias, limiting its clinical use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This single-center prospective study investigates the feasibility and safety of a novel hyperemic protocol involving intravenous (i.v.) lidocaine administration followed by intracoronary papaverine in patients undergoing invasive coronary functional assessment. All patients underwent FFR, CFR, and IMR measurements after receiving an initial dose of 100\u2005mg of i.v. lidocaine followed by papaverine (20\u2005mg for the left coronary artery and 5\u201310\u2005mg for the right coronary artery).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 389 patients were enrolled. Functionally significant stenosis (FFR\u2009\u2264\u20090.80) 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These findings suggest that pre-treatment with lidocaine may enhance the safety of papaverine-induced hyperemia during invasive coronary testing.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2025.1621053","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T05:31:14Z","timestamp":1758173474000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Arrhythmia prevention protocol during papaverine administration for invasive coronary functional assessment"],"prefix":"10.3389","volume":"12","author":[{"given":"Dobrin","family":"Vassilev","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niya","family":"Mileva","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gavril","family":"Stoev","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilter","family":"Pazardzhykly","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Panayot","family":"Panayotov","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianluca","family":"Rigatelli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valery","family":"Gelev","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3415","DOI":"10.1093\/eurheartj\/ehae177","article-title":"2024 ESC Guidelines for the management of chronic coronary syndromes","volume":"45","author":"Vrints","year":"2024","journal-title":"Eur Heart J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1161\/01.CIR.73.3.444","article-title":"Intracoronary papaverine: an ideal coronary vasodilator for studies of the coronary circulation in conscious humans","volume":"73","author":"Wilson","year":"1986","journal-title":"Circulation"},{"key":"B3","doi-asserted-by":"publisher","first-page":"9971874","DOI":"10.1155\/2021\/9971874","article-title":"Simplified assessment of the index of microvascular resistance","volume":"2021","author":"Kodeboina","year":"2021","journal-title":"J Interv Cardiol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1877","DOI":"10.1161\/01.CIR.0000061950.24940.88","article-title":"Intracoronary and intravenous adenosine 5\u2032-triphosphate, adenosine, papaverine, and contrast medium to assess fractional flow reserve in 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severity","volume":"106","author":"Meuwissen","year":"2002","journal-title":"Circulation"},{"key":"B8","doi-asserted-by":"publisher","first-page":"530","DOI":"10.1253\/circj.CJ-14-1118","article-title":"Papaverine-induced polymorphic ventricular tachycardia during coronary flow reserve study of patients with moderate coronary artery disease\u2014analysis of ECG data","volume":"79","author":"Nakayama","year":"2015","journal-title":"Circ J."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1358","DOI":"10.1007\/s00380-018-1175-8","article-title":"Evaluation of the risk factors for ventricular arrhythmias secondary to QT prolongation induced by papaverine injection during coronary flow reserve studies using a 4 Fr angio-catheter","volume":"33","author":"Okabe","year":"2018","journal-title":"Heart Vessels"},{"key":"B10","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1002\/ccd.1810190402","article-title":"Ventricular arrhythmia due to intracoronary papaverine: analysis of QT intervals and coronary vasodilatory reserve","volume":"19","author":"Kern","year":"1990","journal-title":"Cathet Cardiovasc Diagn."}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1621053\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T05:31:14Z","timestamp":1758173474000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1621053\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,18]]},"references-count":10,"alternative-id":["10.3389\/fcvm.2025.1621053"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2025.1621053","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,18]]},"article-number":"1621053"}}