Acute Coronary Occlusion During Radiofrequency Catheter Ablation of Typical Atrial Flutter

Abstract

Acute Coronary Occlusion During RF Catheter Ablation. 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.

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…This region is in close proximity to the RCA, and injury to this vessel has been described. 1236,1237 These have occurred both acutely and later during the case, and with both septal and lateral approaches to the ablation.…”

Transcatheter cryoablation of tachyarrhythmias in children

“…However, challenges remain in terms of the safety and efficacy of RF ablation in specific locations, including the potential for injury to the coronary arteries, particularly when ablating within the coronary sinus and coronary veins (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). There continues to be a significant risk of ablation-induced atrioventricular (AV) block (15), particularly in right septal locations (16).…”

Randomized Comparison of the Continuous vs Point-by-Point Radiofrequency Ablation of the Cavotricuspid Isthmus for Atrial Flutter

“…Acute coronary occlusion secondary to RF ablation has been reported. 14 In the present study, all patients in each group underwent successful ablation of AFL without any complications and postprocedural coronary angiography revealed no coronary artery injuries.…”