Induction of atrial fibrillation with adenosine during a transesophageal electrophysiology study to risk stratify a patient with asymptomatic ventricular preexcitation.
An asymptomatic adolescent male athlete was incidentally found to have ventricular preexcitation on electrocardiogram during a sports preparticipation physical. A transesophageal electrophysiology study (TEEPS) was performed after an exercise stress test failed to delineate the patient's risk of sudden cardiac death. The TEEPS was favored in this case over a transvenous electrophysiology study due to reduced invasiveness. The goal of the TEEPS was to place the patient into atrial fibrillation (AFib) and evaluate the shortest preexcited RR interval during AFib, thereby assessing the risk of his accessory pathway. Conventional pacing modalities were unable to induce AFib. During atrial burst pacing, adenosine was then administered, which successfully induced AFib. This case highlights adenosine's potential to induce atrial fibrillation during transesophageal electrophysiology studies when atrial pacing alone was unable to do so.
Department of Pediatrics, Tulane University, New Orleans, LA, USA.
Walter J
WJ
Hoyt
Patricia E
PE
Thomas
Christopher S
CS
Snyder
D058606:Accessory Atrioventricular Bundle; D000200:Action Potentials; D000241:Adenosine; D000293:Adolescent; D058070:Asymptomatic Diseases; D056352:Athletes; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology; D002304:Cardiac Pacing, Artificial; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D022062:Electrophysiologic Techniques, Cardiac; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D033162:Incidental Findings; D008297:Male; D011226:Pre-Excitation Syndromes / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D011237:Predictive Value of Tests; D012032:Refractory Period, Electrophysiological; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
D000241:Adenosine