Acute massive pulmonary embolism after radiofrequency catheter ablation: A rare complication after a common procedure

Hung, Chi‐Ren; Lin, Teng-Li; Hsieh, Yu‐Cheng; Lee, Wen-Lieng; Huang, Jin‐Long; Chang, Wei-Chun; Ting, Chih‐Tai; Wu, Tai‐Hsi

doi:10.1016/j.jcma.2011.07.002

Cited by 5 publications

(9 citation statements)

References 13 publications

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“…PE complicated by EPS is rare, with previous studies demonstrating an overall incidence of 0–0.25 % [ 14 – 17 ]. PE following EPS can be either benign and asymptomatic, or symptomatic with life-threatening consequences requiring urgent intervention [ 8 , 11 , 14 , 15 ]. There are various risk factors associated with VTE, including obesity, immobilization, hospitalization, malignancy, long flights, the use of the combined oral contraceptive pill, and central venous catheterization [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary embolism as a complication of an electrophysiological study: a case report

et al. 2016

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BackgroundElectrophysiological studies have become an established practice in the evaluation and treatment of arrhythmias. Symptomatic pulmonary embolism as a result of deep vein thrombosis arising from multiple venous sheath femoral vein catheterization is an uncommon complication associated with it. We report the case of a 33-year-old woman who developed pulmonary embolism after an electrophysiological study, which was successfully treated at a cardiac hospital in Bangladesh.Case presentationA 33-year-old Bangladeshi woman with hypertension and diabetes had initially presented with recurrent episodes of paroxysmal atrial fibrillation that manifested as palpitations for 2 years. Her atrial fibrillation was drug-refractory and could not be attributed to a treatable etiology. She had undergone an electrophysiological study at a different hospital, where right femoral venous catheterization was performed followed by the insertion of three venous sheaths. However, tachyarrhythmia could not be induced and a procedure to isolate the pulmonary vein was postponed because all the veins could not be isolated. Forty-eight hours later, she presented to our hospital with shortness of breath, chest heaviness, palpitations, and recurrent episodes of syncope.She had normal coronary arteries and no other risk factors for venous thromboembolism. She was hemodynamically stable on examination. There was echocardiographic evidence of pulmonary hypertension and right ventricular dilatation and dysfunction. A computed tomography pulmonary angiogram confirmed pulmonary embolus in the descending branch of her left pulmonary artery, extending up to the segmental arteries.Subsequently, a duplex ultrasound confirmed acute deep vein thrombosis affecting her right ilio-femoral segment. She was successfully managed with subcutaneous enoxaparin and oral warfarin (target international normalized ratio 2.5–3).ConclusionsPulmonary embolism is a rare but serious complication that may occur in patients who undergo electrophysiological studies. Multiple venous sheaths inserted into the femoral vein and catheter-induced endothelial injury, further compounded by prolonged procedural time, may be responsible for the increased thrombogenicity leading to deep vein thrombosis and subsequent pulmonary embolism. An adequate observation time after the procedure and clinical alertness are necessary for rapid diagnosis and treatment.

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Section: Discussionmentioning

confidence: 99%

Pulmonary embolism as a complication of an electrophysiological study: a case report

et al. 2016

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“…Another important finding was that all of the patients had a long-duration hemostasis procedure (elastic bandage compression time for 24 hours and immobilization time for 24 hours) and bed rest (24 hours) for the femoral artery sheath. Hand compression and the elastic bandage at the punctured sites of the right femoral artery may also compress the right femoral vein simultaneously 7 leading to venous stasis, especially in case 1. The patient without femoral vein cannulation in case 1 developed acute massive PE after RFCA.…”

Section: Discussionmentioning

confidence: 99%

“…A duplex ultrasonography before getting up to walk to evaluate thrombus formation at the compressed and/or punctured femoral veins may be appropriate for patients with a potential risk for DVT. 7 …”

Section: Discussionmentioning

confidence: 99%

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Clinical Features of Acute Massive Pulmonary Embolism Complicated by Radiofrequency Ablation

Lin²,

Wu³

et al. 2015

Medicine

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Although pulmonary embolism (PE) complicated by radiofrequency catheter ablation (RFCA) is rare, it can be life-threatening. Our goal was to elucidate the clinical features of acute massive PE after RFCA.Of 2386 patients who underwent RFCA for supraventricular tachycardia or idiopathic ventricular arrhythmia, 4 patients (0.16%) whose cases were complicated by acute massive PE were examined.These 4 patients were female and middle-aged (range 43–52 years), and 2 of the 4 patients had iron-deficiency anemia and reactive thrombocytosis. Ablation in all patients was performed in the left heart via the right femoral arterial approach. All of the patients had a long-duration hemostasis procedure and bed rest following femoral arterial sheath removal after RFCA. All of the patients collapsed and lost consciousness during their ﬁrst attempt at walking after RFCA. The emergent electrocardiogram in 2 of the 4 patients revealed an S1Q3T3 pattern, 1 patient demonstrated new onset of right bundle-branch block (RBBB) and S1Q3 pattern and Qr pattern in V1, and the remaining patient had negative T waves in leads V1, V2, and III. The emergent echocardiogram revealed right ventricular hypokinesis and pulmonary hypertension in the 4 patients with acute PE after ablation. Although all of the patients initially experienced sinus tachycardia when they recovered consciousness, 2 of the 4 patients suddenly developed intense bradycardia and lost consciousness again, and these patients finally died (50% fatality rate). All of the patients were identiﬁed by CT pulmonary angiography or pulmonary angiography.Our report suggests that although acute massive PE is highly rare, there is a real and fatal risk in patients who experienced acute massive PE after RFCA. Particular attention should be paid to the first ambulation after RFCA. Acute PE should be strongly suspected when sudden loss of consciousness occurs upon mobilization after RFCA. The new onset of S1Q3T3 pattern, RBBB or T wave inversion in the right precordial leads, and early detection of echocardiographic right ventricular dysfunction may be useful for making an early diagnosis of acute PE after RFCA. Early ambulation after left-sided RFCA might be helpful to prevent the formation of deep venous thrombosis and subsequent PE.

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“…Electrophysiological measurements for validation of CTI block are usually performed using 2 or 3 catheters. However, in some situations this multi-catheter approach may not be possible or is associated with increased periprocedural risk 4, 5, 6, 7. In such cases, the already implanted permanent pacemaker may be used to perform electrophysiological maneuvers.…”

Section: Introductionmentioning

confidence: 99%

Single-catheter validation of bidirectional block during atrial flutter ablation

Futyma¹,

Futyma²,

Dudek³

et al. 2016

HeartRhythm Case Reports

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Acute massive pulmonary embolism after radiofrequency catheter ablation: A rare complication after a common procedure

Cited by 5 publications

References 13 publications

Pulmonary embolism as a complication of an electrophysiological study: a case report

Pulmonary embolism as a complication of an electrophysiological study: a case report

Clinical Features of Acute Massive Pulmonary Embolism Complicated by Radiofrequency Ablation

Single-catheter validation of bidirectional block during atrial flutter ablation

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