Induction of atrial fibrillation with adenosine during a transesophageal electrophysiology study to risk stratify a patient with asymptomatic ventricular preexcitation

Congenit Heart Dis. 2013 Jul-Aug;8(4):E99-E101. doi: 10.1111/j.1747-0803.2012.00682.x. Epub 2012 Jun 8.


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.

Keywords: Adenosine; Asymptomatic Ventricular Preexcitation; Transesophageal Electrophysiology Study.

Publication types

  • Case Reports

MeSH terms

  • Accessory Atrioventricular Bundle
  • Action Potentials
  • Adenosine*
  • Adolescent
  • Asymptomatic Diseases
  • Athletes*
  • Atrial Fibrillation / diagnosis*
  • Atrial Fibrillation / physiopathology
  • Cardiac Pacing, Artificial
  • Death, Sudden, Cardiac / etiology*
  • Electrophysiologic Techniques, Cardiac*
  • Heart Conduction System / physiopathology*
  • Humans
  • Incidental Findings
  • Male
  • Pre-Excitation Syndromes / complications
  • Pre-Excitation Syndromes / diagnosis*
  • Pre-Excitation Syndromes / physiopathology
  • Predictive Value of Tests
  • Refractory Period, Electrophysiological
  • Risk Assessment
  • Risk Factors
  • Time Factors


  • Adenosine