A cardiology case in a young patient

Case: 24 years old male with no past medical history presented to ER with SVT (Supraventricular Tachycardia). His heart rate is 210. Patient was given Adenosine and went into ventricular fibrillation. CPR started and converted to NSR (normal sinus rhythm) with cardioversion. What is your first thought?

Answer: Wolff-Parkinson-White syndrome (WPW)

People with WPW syndrome have an extra electrical pathway between the atria and the ventricles. This "accessory pathway," is also known as the bundle of Kent. This accessory pathway may conduct electrical activity at a significantly higher rate than the AV node, particularly when it is blocked and may degenerate into ventricular fibrillation.

Adenosine and other AV node blockers should be avoided, including calcium channel and beta blockers. Patients with atrial fibrillation and rapid ventricular response are better treated with procainamide or cardioversion in hemodynamic instability.

#cardiology

References:

1. Gupta AK, Shah CP, Maheshwari A, Thakur RK, Hayes OW, Lokhandwala YY. Adenosine induced ventricular fibrillation in Wolff-Parkinson-White syndrome. Pacing Clin Electrophysiol. 2002 Apr;25(4 Pt 1):477-80. doi: 10.1046/j.1460-9592.2002.00477.x. PMID: 11991373.

2. Walker KW, McAnulty JH, Kron J, Silka MJ, Halperin BD. Unmasking accessory pathway conduction with adenosine-induced atrioventricular nodal block after radiofrequency catheter ablation. Chest. 1993 Nov;104(5):1614-6. doi: 10.1378/chest.104.5.1614. PMID: 8222839.

3. Bartlett TG, Friedman PL. Current management of the Wolff-Parkinson-White syndrome. J Card Surg. 1993 Jul;8(4):503-15. doi: 10.1111/j.1540-8191.1993.tb00401.x. PMID: 8353339.

4. Redfearn DP, Krahn AD, Skanes AC, Yee R, Klein GJ. Use of medications in Wolff-Parkinson-White syndrome. Expert Opin Pharmacother. 2005 Jun;6(6):955-63. doi: 10.1517/14656566.6.6.955. PMID: 15952923.