Nicorandil-induced asystole during angioplasty: A rare complication!

Nicorandil is an antianginal medication with a dual mechanism of action. It acts as a vasodilator, similar to nitrates, and also activates ATP-sensitive potassium (K ATP ) channels. Sustained K ATP channel activation leads to a potassium ion (K + ) efflux, causing the cell membrane to hyperpolarize. This hyperpolarization shortens the duration of the action potential, resulting in tissue refractoriness and conduction ablnormalities. We present a case of possible intracoronary nicorandil-induced AV block and prolonged asystole. We believe this raises concerns about the safety of intracoronary nicorandil despite its rarity.