Induction of Atrial Fibrillation with Adenosine during a Transesophageal Electrophysiology Study to Risk Stratify a Patient with Asymptomatic Ventricular Preexcitation

Abstract

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.

Drug-Induced Atrial Fibrillation / Atrial Flutter

“…Среди кардиотонических ЛС частота ЛИФП достигает 23,3% для допамина [41,60], 18% -для добутамина [41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] и 12% -для аденозина [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]. Известно, что прием антиаритмических ЛС способен также провоцировать развитие ЛИФП: пропафенона -в 6% случаев [67,79,80], амиодарона -в 9% [67][68][69][70][71][72] и флекаинида (не зарегистрирован в Российской Федерации для применения) -в 1,3% случаев [79,…”

Successful risk stratification of a patient with ventricular preexcitation by improved transesophageal electrophysiological study

“…Therefore, the real refractory period of accessory pathway is less than 210 MS, suggesting high‐risk accessory pathway. Because the measurement of antegrade refractory period of accessory pathway is easily affected by atrial refractory period, some researchers believe that measuring the shortest RR interval of AF induced by intracardiac electrophysiology is a reliable index to predict high‐risk preexcitation patients, one literature reported the use of adenosine to increase the chance of inducing atrial fibrillation during TEEPS to enable risk stratification in asymptomatic patients with ventricular preexcitation(Hoyt et al., 2013b). Although this method is relatively effective, it also has the risk of causing atrial fibrillation and then developing into ventricular fibrillation.…”