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Risk Stratification of an Accessory Pathway Using Isoproterenol after Cardiac Arrest

A 43-year-old man presented after ventricular fibrillation cardiac arrest with evidence of pre-excited atrial fibrillation. Electrophysiology study with guideline-directed testing demonstrated a low risk accessory pathway effective refractory period, which became high-risk with isoproterenol infusion. This case represents a challenging scenario wherein a high-risk pathway may be misclassified using the currently indicated methods of risk stratification.

Credits: Barry Burstein MD, Rodrigo Barbosa MD, Maude Peretz-Larochelle MD, Michelle Samuel MPH, Vidal Essebag MD PhD, Martin L Bernier MD