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Ventricular fibrillation with intracoronary adenosine during fractional flow reserve assessment

Zubair A Khan1, Ghulam Akbar2, Wajeeha Saeed3

  • 1Cooper University Hospital, Camden, NJ 08103, USA.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|August 2, 2016
PubMed

Insights

Intracoronary adenosine for fractional flow reserve measurement can induce ventricular fibrillation, a rare but serious complication. Prompt defibrillation is crucial for patient recovery and successful hemodynamic assessment.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Electrophysiology

Background:

  • Fractional flow reserve (FFR) assesses intermediate coronary lesions impacting long-term outcomes.
  • Intracoronary (IC) adenosine bolus is a common, user-friendly method for hyperemia induction during FFR, despite potential atrioventricular block.
  • A 62-year-old male with NSTEMI presented with an intermediate lesion in the left anterior descending artery.

Observation:

  • During FFR assessment using IC adenosine, the patient developed ventricular fibrillation (VF).
  • The patient had a history of left bundle branch block and lateral T-wave inversions on ECG.

Findings:

  • IC adenosine administration precipitated VF, a rare complication during FFR.
  • Successful resuscitation was achieved with a single 200J defibrillation shock.

Implications:

  • This case highlights the rare risk of VF during IC adenosine-induced hyperemia for FFR.
  • Clinicians must be prepared for immediate management of life-threatening arrhythmias.
  • Despite the risk, IC adenosine remains a valuable tool for hemodynamic assessment when managed appropriately.

Keywords:
Fractional flow reservePercutaneous coronary interventionVentricular fibrillation

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