Acute Myocardial Infarction after Radiofrequency Catheter Ablation of Typical Atrial Flutter

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Abstract

A 53-yr-old man underwent radiofrequency ablation to treat persistent atrial flutter. After the procedure, the chest pain was getting worse, and the electrocardiogram showed ST-segment elevation in inferior leads with reciprocal changes. Immediate coronary angiography showed total occlusion with thrombi at the distal portion of the right coronary artery, which was very close to the ablation site. Intervention with thrombus aspiration and balloon dilatation was successful, and the patient recovered without any kind of sequelae. Although the exact mechanism is obscure, the most likely explanation is a thermal injury to the vascular wall that ruptured into the lumen and formed thrombus. Vasospasm and thromboembolism can also be other possibilities. This case raise the alarm to cardiologists who perform radiofrequency ablation to treat various kinds of cardiac arrhythmias, in that myocardial infarction has been rarely considered one of the complications.

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Most cited references 13

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Acute coronary occlusion during radiofrequency catheter ablation of typical atrial flutter.

Sana Ouali, Frederic Anselme, Alain Cribier … (2002)

We report the first case of acute right coronary artery occlusion in an adult patient during radiofrequency catheter ablation of typical atrial flutter. ST segment elevation rapidly resolved with antithrombotic therapy. This complication was thought to be due to the short distance between the endocardium and the right coronary artery at the ablation site, the high-wattage output from the radiofrequency generator, and the lack of sufficient cooling effect related to a severe upstream coronary stenosis. In patients with known right coronary artery stenosis who are suffering from typical atrial flutter, evaluation of the significance of the stenosis would be reasonable.

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Coronary artery involvement early and late after radiofrequency current application in young pigs.

Thomas Paul, Regina Bökenkamp, Britta Mahnert … (1997)

Radiofrequency current (500 kHz) was delivered by temperature guidance (75 degrees C) over a 30-second period in 10 young piglets with a steerable 6F electrode catheter equipped with a thermistor at the 4 mm tip electrode. Lesions were created at the right atrial aspect of the tricuspid valve anulus, at the left ventricular myocardium under the lateral mitral valve anulus, and at the left ventricular apex. After 48 hours, five animals were randomly sacrificed. Lesions in the five animals appeared as transmural gray-white coagulation necrosis. Lymphocytic infiltration around the right atrial lesions extended into the layers of the right coronary artery in four of five animals. After 6 months, lesions consisted of compact fibrous tissue in the remaining five animals. Right atrial lesions extended to the layers of the right coronary artery in four of five pigs. In two animals the lumen of the right coronary artery was narrowed because of intimal thickening by 25% and 40%, respectively. No increase in the lesion size was observed with the growth of the animals. Effects on the right coronary artery as a late sequela after radiofrequency current application may also be possible in human beings and should be considered when radiofrequency current ablation procedures are proposed in infants and young children.

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Right coronary artery occlusion during RF ablation of typical atrial flutter.

Ila Bharati, Richard G Trohman, Lida Mina … (2010)

Right coronary artery (RCA) occlusion and acute myocardial infarction are rare during radiofrequency (RF) ablation of the cavotricuspid isthmus. Ventricular fibrillation (VF) or cardiac arrest in the periprocedural period may be the initial or only clinical manifestation. Septal or lateral RF delivery may increase the risk. We report 2 cases of RCA occlusion during ablation of typical atrial flutter (AFL). Angiographic and anatomical correlations are illustrated. One patient was ablated with a septal approach, the other with a lateral approach, and in each instance the RCA occluded near the ablative lesions. If septal or lateral ablation lines are contemplated during ablation of isthmus-dependent atrial flutter, fluoroscopic or electroanatomic confirmation of catheter position is pivotal. Smaller tipped catheters, energy titration (to minimally effective dose), saline irrigation, or cryoablation should also be considered to help avoid this serious complication.

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Author and article information

Journal

Journal ID (nlm-ta): J Korean Med Sci

Journal ID (iso-abbrev): J. Korean Med. Sci

Journal ID (publisher-id): JKMS

Title: Journal of Korean Medical Science

Publisher: The Korean Academy of Medical Sciences

ISSN (Print): 1011-8934

ISSN (Electronic): 1598-6357

Publication date (Print): February 2014

Publication date (Electronic): 28 January 2014

Volume: 29

Issue: 2

Pages: 292-295

Affiliations

[1 ]Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

[2 ]Division of Cardiolgy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Author notes

Address for Correspondence: June Soo Kim, MD. Division of Cardiolgy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea. Tel: +82.2-3410-3414, Fax: +82.2-3410-3849, js58.kim@ 123456samsung.com

Author information

Sehyo Yune http://orcid.org/0000-0002-9223-3586

Woo Joo Lee http://orcid.org/0000-0002-4790-3560

Ji-won Hwang http://orcid.org/0000-0002-7098-3546

Eun Kim http://orcid.org/0000-0001-9401-7388

Jung Min Ha http://orcid.org/0000-0002-0075-4449

June Soo Kim http://orcid.org/0000-0001-7569-6450

Article

DOI: 10.3346/jkms.2014.29.2.292

PMC ID: 3924013

SO-VID: c78dcc92-6199-4374-8d83-a3cf344bffa7

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Acute Myocardial Infarction after Radiofrequency Catheter Ablation of Typical Atrial Flutter

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Karger: Cardiovascular System

Most cited references 13

Acute coronary occlusion during radiofrequency catheter ablation of typical atrial flutter.

Coronary artery involvement early and late after radiofrequency current application in young pigs.

Right coronary artery occlusion during RF ablation of typical atrial flutter.

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