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Coronary air embolism complicating transseptal radiofrequency ablation of left free-wall accessory pathways
M D Lesh1, D L Coggins, T A Ports
1Department of Medicine, University of California, San Francisco 94143.
Insights
Radiofrequency catheter ablation effectively treats tachycardia. A rare complication, air embolism, can occur during transseptal procedures, highlighting the need for careful technique during catheter exchanges.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Radiofrequency catheter ablation is a key curative treatment for accessory pathway-mediated tachycardia.
- Left free-wall accessory pathway ablation can utilize retrograde transarterial or transseptal approaches with long vascular sheaths.
Observation:
- Air embolization into the coronary artery was observed during a transseptal ablation procedure.
- This complication was temporally linked to a catheter exchange maneuver.
Findings:
- The observed air embolism, while not causing permanent harm, underscores a potential risk associated with transseptal approaches.
- Meticulous attention to preventing air introduction is crucial when using long vascular sheaths across the atrial septum.
Implications:
- This case highlights the importance of careful technique to prevent air embolism during transseptal catheter procedures.
- Recommendations include slow catheter withdrawal and continuous flushing with heparinized saline during exchanges to mitigate risk.
Abstract:
Radiofrequency catheter ablation is an important new technique for curing patients with accessory pathway-mediated tachycardia. Ablation of left free-wall accessory pathways may be accomplished either by a retrograde, transarterial approach or via a transseptal approach using a long vascular sheath. We describe air embolization into the coronary artery as a complication of the transseptal approach, which was temporally associated with catheter exchange. While there were no permanent adverse sequelae, this report emphasizes the need for scrupulous attention to the possible insinuation of air during procedures involving long vascular sheaths across the atrial septum. To prevent air embolism, we recommend slow removal of the ablation catheter along with continuous flushing with heparinized saline during exchanges.