Related Experiment Videos
Coronary ischemia induced by radiofrequency ablation in the left atrium
Ron D B Simon1, Jaswinder S Gill
1Department of Adult Cardiology, Guy's and St. Thomas' Hospital NHS Trust, London, United Kingdom. rsimon@auberlac.aflex.net
Insights
Radiofrequency ablation in the left atrium can cause temporary coronary artery spasm and ischemia. This reversible condition was successfully treated with intracoronary nitrates in three patients.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Radiofrequency ablation is a common procedure for treating cardiac arrhythmias.
- Left atrial ablation targets specific areas to correct abnormal heart rhythms.
Observation:
- Three patients developed transient coronary ischemia following left atrial radiofrequency ablation.
- Symptoms included ST-segment elevation on electrocardiograms, indicating myocardial injury.
- Coronary angiography revealed occluded or slow-flowing coronary arteries in affected patients.
Findings:
- Left atrial ablation, particularly at the roof, septum, and left inferior wall, can precipitate coronary artery spasm.
- This spasm leads to reversible myocardial ischemia.
- Intracoronary nitrates effectively resolved the coronary artery spasm and ischemic changes.
Implications:
- Clinicians should be aware of this potential complication of left atrial ablation.
- Prompt recognition and treatment with nitrates can prevent adverse cardiac events.
- Further research is needed to elucidate the exact mechanism of spasm induction.
Introduction:
We report three cases of transient, reversible coronary ischemia occurring after radiofrequency ablation in the left atrium.
Methods And Results:
A 56-year-old man with a left atrial tachycardia that was mapped to the septum and roof of the atrium using a noncontact mapping developed 5-mm ST elevation in the anterolateral leads. Coronary angiography showed an occluded diagonal that was opened using intracoronary nitrate, which led to resolution of the ST changes. A 57-year-old man undergoing right upper pulmonary vein ablation developed 6-mm ST elevation in leads V1-V4, II, III, and aVF. Coronary angiography showed normal coronaries with slow flow into the left anterior descending artery, which resolved with nitrates. A 50-year-old man undergoing left lower pulmonary vein ablation developed 3-mm reversible inferior ST elevation. All patients were adequately anticoagulated after transseptal access to the left atrium.
Conclusion:
Ablation in the left atrium, at the roof, septum, and left inferior wall, can cause transient coronary ischemia, possibly due to spasm, which can be reversed with intracoronary nitrates. This phenomenon has not been previously described.