Utility of Intracoronary Acetylcholine Provocation Testing in Inducing Atrial Fibrillation with Preexcitation Followed by Ventricular Fibrillation in a Patient with Wolff-Parkinson-White Syndrome: A Case Report

Akira Saito; Chisaki Mochida; Atsushi Mizuno; Keita Masuda

doi:10.2169/internalmedicine.3000-23

Utility of Intracoronary Acetylcholine Provocation Testing in Inducing Atrial Fibrillation with Preexcitation Followed by Ventricular Fibrillation in a Patient with Wolff-Parkinson-White Syndrome: A Case Report

Intern Med. 2024 Feb 19. doi: 10.2169/internalmedicine.3000-23. Online ahead of print.

Authors

Akira Saito¹, Chisaki Mochida¹, Atsushi Mizuno¹, Keita Masuda¹

Affiliation

¹ Department of Cardiology, St Luke's International University, Japan.

PMID: 38369356
DOI: 10.2169/internalmedicine.3000-23

Abstract

A 20-year-old man was resuscitated after ventricular fibrillation (VF). Electrocardiography revealed Wolff-Parkinson-White (WPW) syndrome. Intracoronary acetylcholine provocation testing was performed to induce VF secondary to the coronary vasospasm. The administration of acetylcholine to the coronary artery induced atrial fibrillation (AF) with pre-excitation, followed by VF without coronary vasospasm. Electrophysiological studies revealed an accessory pathway managed by catheter ablation. Subsequent intracoronary acetylcholine provocation testing (ACH test) induced the occurrence of AF without preexcitation. To our knowledge, this case report is the first to demonstrate the utility of the ACH test in confirming WPW syndrome as a cause of VF.

Keywords: Wolff-Parkinson-White syndrome; acetylcholine provocation testing; atrial fibrillation; catheter ablation; sudden cardiac death; ventricular fibrillation.