title: Ventricular fibrillation with intracoronary adenosine during fractional flow reserve assessment.
abstract: Fractional flow reserve (FFR) measurement provides useful hemodynamic assessment of intermediate coronary stenoses affecting long term outcomes. While the gold standard remains intravenous adenosine, intracoronary (IC) bolus administration of adenosine is routinely used in clinical practice because of its ease of use and lower dose providing comparative hyperemia with the most common side effect being a transient atrioventricular block. A 62year old male underwent left heart catheterization after ruling in for non-ST elevation myocardial infarction (NSTEMI). Presenting electrocardiogram (ECG) showed an old left bundle branch block and T-wave inversions in lateral leads (QTc 494ms) with no significant electrolyte abnormalities. Coronary angiography revealed an intermediate lesion in mid left anterior descending coronary artery. FFR assessment with IC adenosine (24μg/mL of normal saline) was performed inducing ventricular fibrillation (VF). He was successfully defibrillated with a single 200J shock and no further arrhythmias were noticed during rest of his hospital stay.
authors.affiliation: Cooper University Hospital, Camden, NJ 08103, USA.
authors.forename: Zubair A
authors.initials: ZA
authors.lastname: Khan
authors.affiliation: Lehigh Valley Hospital, Allentown, PA 18103, USA.
authors.forename: Ghulam
authors.initials: G
authors.lastname: Akbar
authors.affiliation: Albert Einstein College of Medicine, Bronx, NY 10457, USA.
authors.forename: Wajeeha
authors.initials: W
authors.lastname: Saeed
authors.affiliation: Cooper University Hospital, Camden, NJ 08103, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Malik
authors.affiliation: Abington Jefferson Health System, Philadelphia, PA 19001, USA.
authors.forename: Fatima
authors.initials: F
authors.lastname: Khan
authors.affiliation: Cooper University Hospital, Camden, NJ 08103, USA; Rhode Island Hospital, Brown University, Warren, Alpert School of Medicine, RI 02903, USA. Electronic address: rizwansardar@hotmail.com.
authors.forename: Muhammad Rizwan
authors.initials: MR
authors.lastname: Sardar
mesh_terms: D000241:Adenosine / Q000008:administration & dosage / Q000009:adverse effects*; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D047548:Defibrillators; D004554:Electric Countershock / Q000295:instrumentation; D004562:Electrocardiography; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D000072658:Non-ST Elevated Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology; D011237:Predictive Value of Tests; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000009:adverse effects*; D014693:Ventricular Fibrillation / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine
keywords: Fractional flow reserve; Percutaneous coronary intervention; Ventricular fibrillation