Torsades de Pointes associated with QT prolongation after catheter ablation of paroxysmal atrial fibrillation

Abstract

A 79-year-old woman who underwent catheter ablation for paroxysmal atrial fibrillation presented with Torsades de Pointes (TdP). Aggravation of prolonged QT interval which is most likely due to neural modulation by catheter ablation, played major role in the initiation of TdP. The patient was successfully treated with isoproterenol during acute stage and discharged after stabilization without implantation of permanent pacemaker or implantable cardioverter defibrillator.

Prolongation of QT interval after pulmonary vein isolation for paroxysmal atrial fibrillation

“…In contrast, the QT interval is strongly affected by autonomic conditions 9,10 and was strongly associated with AF development 11 . There are also several reports on QT prolongation and lethal ventricular arrhythmias related to PVI 12,13 …”

“…11 There are also several reports on QT prolongation and lethal ventricular arrhythmias related to PVI. 12,13 PVI might impact QT interval through ANS due to GP modification, but its influence on QT interval in humans has not yet been fully investigated. This study aimed to evaluate the change of QT interval after PVI in human subjects and determine the risk factors for QT increase after PVI.…”

A case of a late fatal complication after atrial fibrillation ablation related to a prolonged QT interval unmasked by atrial fibrillation ablation

“…Ganglionated plexi have been reported to exist around pulmonary vein region and vagal denervation can be antiarrhythmic in the atria, but can be pro-arrhythmic in the ventricle [6]. In the previous case report [5], a pacing device was not implanted after isoproterenol infusion and coronary intervention during the acute stage. However, we decided to implant an ICD, because our patient had a history of non-ischemic cardiomyopathy, which could be a risk for polymeric VT.…”

“…Ventricular tachyarrhythmia after catheter ablation of AF is a rare complication and only a limited case report has been described [5]. Ganglionated plexi have been reported to exist around pulmonary vein region and vagal denervation can be antiarrhythmic in the atria, but can be pro-arrhythmic in the ventricle [6].…”

Torsade de Pointes Due to QT Prolongation after Pulmonary Vein Isolation for Persistent Atrial Fibrillation

“…GP ablation carries a risk of increasing atrial and ventricular vulnerability to arrhythmias, and GP ablation induced QT prolongation after myocardial infarction in a canine model ( 3 , 4 , 5 ). QT prolongation and lethal ventricular arrhythmias related to PVI and antiarrhythmic drugs have also been reported ( 6 ).…”