Clinical Features of Acute Massive Pulmonary Embolism Complicated by Radiofrequency Ablation

Abstract

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.

Acute Hemodynamic and Tissue Effects of Cryoballoon Ablation on Pulmonary Vessels: The IVUS‐Cryo Study

“…Others speculated16 that multiple mechanisms may cause elevated pulmonary pressures. These include the involvement of the lungs due to PV stenosis,17 PV occlusion, and, rarely, pulmonary embolism 18. Radiofrequency catheter ablation can also lead to scarring of the atrium, which can cause LA diastolic dysfunction, known as LA stiffness , leading to elevated pulmonary pressures 19.…”

“…These include the involvement of the lungs due to PV stenosis, 17 PV occlusion, and, rarely, pulmonary embolism. 18 Radiofrequency catheter ablation can also lead to scarring of the atrium, which can cause LA diastolic dysfunction, known as LA stiffness, leading to elevated pulmonary pressures. 19 One study evaluated cryoballoon-related scar in the left atrium and found that only %27% of the posterior wall remained unablated.…”

Prevention and Treatment of Lower Limb Deep Vein Thrombosis after Radiofrequency Catheter Ablation: Results of a Prospective active controlled Study

“…Most of the definite supraventricular and malignant ventricular arrhythmia may be cured successfully with RFCA procedures215. Although RFCA is a promising technique with minimal invasive surgical technology and high yield-to-complication ratio, there is a likelihood of developing pulmonary thromboembolism and DVT58.…”

Pulmonary Hypertension due to Radiofrequency Catheter Ablation (RFCA) for Atrial Fibrillation: The Lungs, the Atrium or the Ventricle?

“…Pulmonary embolism is another life-threating condition seen post-RFCA which can lead to elevated pulmonary pressures and acute right heart failure. Patients with acute pulmonary embolism usually present within 24 hours of the procedure with acute dyspnoea [24]. Given that AF ablation is usually offered in patients who are therapeutically anticoagulated, this complication in less likely.…”

“…Given that AF ablation is usually offered in patients who are therapeutically anticoagulated, this complication in less likely. It is more commonly seen in patients undergoing RFCA for other supraventricular or ventricular arrhythmias [24].…”