Clinical Studies
Effects of nicorandil, a potassium channel opener, on idiopathic ventricular tachycardia

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Abstract

Objectives. We assessed the effects of the adenosine triphosphate (ATP)–sensitive potassium channel opener, nicorandil, on ATP- and verapamil-responsive ventricular tachycardias (VTs).

Background. Adenosine- or ATP-sensitive VTs are thought to be due to a nonreentrant mechanism, presumably delayed afterdepolarization. We suggest that this potassium channel opener may suppress ATP- and verapamil-sensitive VTs.

Methods. The subjects included 13 patients with idiopathic VTs, 7 of whom had sustained VT and 6 of whom had nonsustained VT. We evaluated the effects of ATP, nicorandil and verapamil on VTs.

Results. Sustained VT: Verapamil had preventive effects on seven VTs. Four VTs were terminated by ATP, and of these, nicorandil terminated two and prevented exercise-induced VT in the two others. Three ATP-insensitive VTs, which were determined to be due to a reentry by an electrophysiologic study, were not terminated by nicorandil. Nonsustained VT: All six VTs were inhibited by ATP, and five of these were suppressed by nicorandil. Verapamil inhibited four of the five VTs. QT intervals and the corrected QT intervals were significantly shortened by nicorandil.

Conclusions. Nicorandil suppresses ATP- and verapamil-responsive VTs. One of the mechanisms of suppression by nicorandil might be related to a reduction of calcium in the myocardium, because it reduces the action potential duration.

Abbreviations

APD
action potential duration
ATP
adenosine triphosphate
LBBB
left bundle branch block
LV
left ventricular
QTc
corrected QT interval
RBBB
right bundle branch block
RV
right ventricular
VPC
ventricular premature contraction
VT
ventricular tachycardia

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This work was supported in part by Grant 09670753 from the Ministry of Education, Science and Culture of Japan.