Adenosine
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Atrial fibrillation: case report. A 68-year-old man developed atrial fibrillation during intracoronary injection of adenosine in a fractional flow reserve evaluation. The man had undergone a right coronary angioplasty in 2016. He presented in a lab for coronary angiogram following abnormal ST segment during a cardiac stress test. The baseline ECG showed a complete right bundle branch block and a regular sinus rhythm. The coronary angiogram with right radial access showed average intermediate intrastent restenosis of the right coronary artery and intermediate lesions of the left marginalis. During the angiogram no severe stenosis was found. A fractional flow reserve evaluation for all lesions was ordered using the acyst [sic] microcatheter system. An intracoronary injection of adenosine 150µg was administered, after placing the microcatheter downstream of the lesion. In less than 3 seconds after the injection, fast atrial fibrillation at 125 /min with no preceding sinoatrial block or bradycardia was observed. The fractional flow reserve evaluation tested negative at 0.92 and there was no dilation of the right coronary artery. The man was on cardiac monitoring and treated with intravenous amiodarone, not allowing fast restoration of sinus rhythm with a low molecular weight heparin cover. Oral amiodarone was re-administered again and he was hospitalised overnight. The subsequent day, his sinus rhythm restored and he was discharged. Author comment: "In this Case report, we report an extremely rare case of atrial fibrillation induced by an intracoronary injection of adenosine". Rekik S. Intracoronary adenosine induced-atrial fibrillation during fractional flow reserve evaluation. Annales de Cardiologie et d’Angeiologie 68: 371-374, No. 5, Nov 2019. Available from: URL: http://doi.org/10.1016/j.ancard.2019.07.010 803439024 [French; summarised from a translation] - France
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Reactions 14 Dec 2019 No. 1783
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