What will you learn?
- what is safe range for atrial stimulation
- when can I expect AF induction
- what to look for and be prepared for
About this scenario
- In general extra-stimulus pacing is less likely to induce AF and should be used first.
- Incremental and constant atrial pacing at CL lower than 250ms has the greatest potential to induce AF so usually it is performed at the end of EP study.
- Look for local signal defragmentation as an early warning prior AF induction
- Pacing in 270-240 range might be useful for induction of typical flutter, while short bursts of 300ms should be sufficient to trigger ectopic tachycardia.
- Inducing AF and need for subsequent cardioversion (and/or sedation) has huge impact on outcome of following manoeuvres and the course of the whole study. Therefore accidental induction should be avoided.
- After AF induction you might wait for few minuets and wait for spontaneous conversion or even ask patient to do some Valsalva manoeuvres like holding the breath and pressing.
- AF induction is always a possibility during AF study so you and your team must be prepared for that.
