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

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.     

经食管超声心动图在心血管疾病手术中的应用价值

目的：探讨经食管超声心动图（TEE）在心血管疾病手术中的应用价值。材料与方法：在28例心血管疾病患者中进行了术中TEE检查。结果：术中TEE检查可为手术方式的选择提供直接可靠的依据、及时观察冠脉旁路术中室壁运动改变、主动脉瓣置换术后瓣膜功能状态、胸主动脉层的破口位置和数目及人工血管吻合口情况、连续实时监测术中心功能状态、及时检出术中并发症并指导合理的治疗方案。结论：术中TEE检查可提高手术成功率、减少并发症和死亡率，值得进一步推广应用。     

Mitral valve ring dehiscence with an aorta-left atrial fistula.

In an era with the increasing use of various imaging modalities including echocardiography, ventriculography and cardiac magnetic resonance (CMR) imaging, one must be aware of the limitations of each discipline. We report a case of an individual who presented with both a partial dehiscence of a mitral valve annuloplasty ring and an aorta-left atrium fistula following surgical management of infective endocarditis that was correctly identified using transesophageal echocardiographic imaging.