Abstract
We present the case of a 57 year-old patient that presented to our Institution with a positive treadmill stress test. Coronary angiography revealed an intermediate stenosis of the right coronary artery evaluated with a fractional flow reserve (FFR), complicated by torsade de pointes. Despite this being a very rare arrhythmic complication during FFR, its prompt recognition and treatment are of utmost importance.
A 57-year-old woman with a history of hypertension and dyslipidemia was referred to our Institution to undergo cardiac catheterization due to positive treadmill stress test. Coronary angiogram revealed an intermediate stenosis of the proximal right coronary artery ( Fig. 1 ), without other stenoses on the remaining coronary vessels. Accordingly, a fractional flow reserve (FFR) measurement was planned. Increasing doses of adenosine (40, 80 and 120 μg) as intracoronary boli were administered with an FFR value measured of 0.91 and 0.85 after first and second administration, respectively. After the last dose administration, the patient had a transient heart block, followed by ventricular escape beats and torsade de pointes ( Fig. 2 ). Cardiac defibrillation led to sinus rhythm restoration ( Fig. 3 ). To assess the severity of the stenosis, an intravascular ultrasound examination was then performed, showing a minimum lumen cross-sectional area of 2.3 mm 2 ( Fig. 4 ). Accordingly, a drug-eluting stent (Endeavor Resolute 3.5×15 mm) was successfully implanted ( Fig. 5 ).
