Author + information
- Emmanouil S. Brilakis, MD, PhD⁎ ( and )
- Subhash Banerjee, MD
- ↵⁎Division of Cardiology (111A), VA North Texas Health Care System, The University of Texas, Southwestern Medical Center at Dallas, 4500 South Lancaster Road, Dallas, Texas 75216
The study by De Luca et al. (1) elegantly demonstrates that increasing doses of intracoronary adenosine are associated with incremental reductions in fractional flow reserve. We would like to caution, however, against high-dose intracoronary adenosine administration in the right coronary artery. Although none of the 12 patients who underwent right coronary artery evaluation in the present study had a clinical event, 3 of them developed complete atrioventricular block lasting >4 s. Prolonged complete atrioventricular block can lead to ventricular fibrillation or atrial fibrillation (2), both important complications that may require emergent defibrillation. Hence, intravenous administration may be the preferred route for vasodilator administration for fractional flow reserve measurement in the right coronary artery.
Please note: Dr. Brilakis received speaker honoraria from St. Jude Medical and Terumo; research support from Abbott Vascular and InfraRedx; and his spouse is an employee of Medtronic. Dr. Banerjee received speaker honoraria from St. Jude Medical, Medtronic, and Johnson & Johnson; and received research support from Boston Scientific and The Medicines Company.
- American College of Cardiology Foundation