Atrial Fibrillation Triggered by Adenosine During Fractional Flow Reserve Measurement: Common Arrhythmia in an Uncommon Scenario

Recently, we came across the development of new-onset atrial fibrillation (AF) while performing fractional flow reserve (FFR) for the two patients with borderline lesions of the left anterior descending (LAD) and right coronary arteries (RCA). The use of adenosine for the termination of supraventricular tachycardia is a common indication. The hemodynamic evaluation of a coronary lesion prior to revascularization has grown after the publication of the FAME and FAME 2 trials.1,2 In the catheterization laboratory, intracoronary or intravenous adenosine is used to document the significance of borderline lesions as a vasodilator. Transient bradyarrhythmia is known as an adverse effect. The development of AF following intracoronary or intravenous infusions of adenosine is a rare occurrence.3,4