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

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. (C) 1998 by the American College of Cardiology.