Coronary Artery Injury Due to Catheter Ablation in Adults

Abstract

Background-Currently, only anecdotal information exists on the presentation and outcome of coronary arterial injury after ablation procedures. Methods and Results-Four patients who sustained coronary artery injury of a cohort of patients undergoing 4655 consecutive ablation procedures (0.09%) are described. The patients' mean age was 45Ϯ11 years, and 1.8Ϯ0.5 prior ablation attempts had been unsuccessful. Coronary injury occurred from epicardial ventricular tachycardia ablation in 2 patients (irrigated radiofrequency ablation in one and cryoablation in the other) and ablation within the middle cardiac vein with irrigated radiofrequency in 2 patients. All involved branches of the right coronary artery. Acute occlusion presenting with ST-segment elevation immediately after ablation was recognized during the procedure in 2 cases. Occlusion failed to respond to nitroglycerin or balloon dilation, and stenting was required in both cases. Acute myocardial infarction occurred 2 weeks after epicardial ablation as a result of occlusion of a right ventricular branch of the right coronary artery giving rise to the posterior descending coronary artery in 1 patient. A moderate asymptomatic stenosis was seen on angiography after epicardial cryoablation in 1 patient. All patients recovered and remained asymptomatic from the coronary injury and arrhythmias during 37Ϯ53 months of follow-up. Conclusions-Coronary arterial injury after ablation procedures is rare. It may present acutely or several weeks after an ablation procedure. Acute occlusion appears to require coronary stenting. Unanticipated anatomic variations can predispose to coronary injury.

2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

“…Większość ogniskowych nasierdziowych VT powstaje w pobliżu dużych żył serca lub tętnic wieńcowych [195,[539][540][541] i poważne obawy budzi możliwość uszkodzenia tętnicy wieńcowej [531,[560][561][562]. Przeszkodami anatomicznymi utrudniającymi ablację mogą być również przyległe uszko lewego przedsionka i nasierdziowe poduszeczki tłuszczowe.…”

Anesthetic Management in Radiofrequency Catheter Ablation of Ventricular Tachycardia

“…35 Potential injury includes RV free-wall perforation and damage to the aortic cusps or coronary ostia. 2,36,37 Ablation treatment fails most often because of incomplete mapping or the inability to induce arrhythmia. 6 The outflow tract anatomy in particular is complex, and the electrogram at target sites can easily be missed because of low amplitude.…”

Catheter Ablation for Ventricular Arrhythmias

“…Ablation close to a coronary artery poses a risk of acute coronary occlusion and should be avoided. 7,13 In our laboratory we tend to maintain a minimum distance of 5 mm from an epicardial coronary artery. Left phrenic nerve injury is another concern and high output pacing is performed prior to ablation along the anatomical course of the nerve to assess proximity of the nerve.…”

“…8 With increasing experience in catheter ablation of ventricular arrhythmias, ablation is being considered earlier in the course of the arrhythmia. 13 Patients are no longer required to exhaust antiarrhythmic drug therapy or present with a VT storm (commonly defined as three or more VT episodes within 24 hours) in order to be considered for ablation. 7 The recognition that VT is associated with adverse outcomes despite the presence of an ICD raises the question as to whether ablation should be performed prophylactically in patients who are receiving an ICD after their first arrhythmic event.…”