Intra-procedural arrhythmia during cardiac catheterization: A systematic review of literature

Abstract

BACKGROUND Cardiac catheterization is among the most performed medical procedures in the modern era. There were sporadic reports indicating that cardiac arrhythmias are common during cardiac catheterization, and there are risks of developing serious and potentially life-threatening arrhythmias, such as sustained ventricular tachycardia (VT), ventricular fibrillation (VF) and high-grade conduction disturbances such as complete heart block (CHB), requiring immediate interventions. However, there is lack of systematic overview of these conditions. AIM To systematically review existing literature and gain better understanding of the incidence of cardiac arrhythmias during cardiac catheterization, and their impact on outcomes, as well as potential approaches to minimize this risk. METHODS We applied a combination of terms potentially used in reports describing various cardiac arrhythmias during common cardiac catheterization procedures to systematically search PubMed, EMBASE and Cochrane databases, as well as references of full-length articles. RESULTS During right heart catheterization (RHC), the incidence of atrial arrhythmias (premature atrial complexes, atrial fibrillation and flutter) was low (< 1%); these arrhythmias were usually transient and self-limited. RHC associated with the development of a new RBBB at a rate of 0.1%-0.3% in individuals with normal conduction system but up to 6.3% in individuals with pre-existing left bundle branch block. These patients may require temporary pacing due to transient CHB. Isolated premature ventricular complexes or non-sustained VT are common during RHC (up to 20% of cases). Sustained ventricular arrhythmias (VT and/or VF) requiring either withdrawal of catheter or cardioversion occurred infrequently (1%-1.3%). During left heart catheterizations (LHC), the incidence of ventricular arrhythmias has declined significantly over the last few decades, from 1.1% historically to 0.1% currently. The overall reported rate of VT/VF in diagnostic LHC and coronary angiography is 0.8%. The risk of VT/VF was higher during percutaneous coronary interventions for stable coronary artery disease (1.1%) and even higher for patients with acute myocardial infarctions (4.1%-4.3%). Intravenous adenosine and papaverine bolus for fractional flow reserve measurement, as well as intracoronary imaging using optical coherence tomography have been reported to induce VF. Although uncommon, LHC and coronary angiography were also reported to induce conduction disturbances including CHB. CONCLUSION Cardiac arrhythmias are common and potentially serious complications of cardiac catheterization procedures, and it demands constant vigilance and readiness to intervene during procedures.

Characteristics of Patients with Ventricular Septal Defect that Had Been Closed with Transcatheter in Dr. Soetomo General Hospital from January 2019 to December 2021

“…Isolated NSVT or PVC events often occur during right heart catheterization, that is, when the catheter tip enters the right atrium, right ventricle, pulmonary artery with a percentage of about 20%. 25 Other complication in this study was mild qualitative aortic valve regurgitation in 3.7% of the total 27 samples and no new case of tricuspid regurgitation was found from a total of 27 samples in this study shortly after the transcatheterization procesure. In a study conducted by Liu et al, (2013), it was found that the emergence of new cases of aortic valve regurgitation was 1.37% and tricuspid regurgitation was only around 0.57% of a total of 871 samples.…”

Retrieving embolized peripherally inserted central catheter – A novel two step technique

“…The reverse curve grants it pushability, control and fineness, in comparison to pigtail catheters which have a tendency to curl inside and can become difficult to manoeuvre and require more time in manipulation. Considering the fact that longer time spent manipulating catheters in the cardiac chamber is associated with arrhythmia [17] – both transient and life-threatening – SIM 1 catheter is ideal for a quick retrieval. The soft tip and ability to use the contralateral wall for support makes SIM 1 catheter a very useful device to hook IFB.…”

Contrast‐induced early repolarization pattern and ventricular fibrillation

“…Malignant arrhythmogenesis is not an uncommon complication during invasive coronary angiography, even though its incidence has declined nearly by half during the last decades (1.1% sVT/VF in 1960 vs. 0.6% in 1990). 1 The majority of these events is related to catheter and wire manipulations (direct myocardial stimulation, deep coronary intubation, superselective engagement etc) and can be prevented by optimizing the equipment and the technique such as preferring smaller size catheters with sideholes, avoid prolonged injections of large amount of contrast medium, or injections into the conus branch of the right coronary artery. 2 Whenever the aforementioned technical issues have been excluded as the cause of the arrhythmic event, the etiology can be attributed to myocardial toxicity of the contrast agent or underlying vulnerability of the patient due to electrolyte imbalance or QT prolongation.…”

“…Malignant arrhythmogenesis is not an uncommon complication during invasive coronary angiography, even though its incidence has declined nearly by half during the last decades (1.1% sVT/VF in 1960 vs. 0.6% in 1990) 1 2 …”