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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

ST-segment elevation induced during the transseptal procedure for radiofrequency catheter ablation of atrial

Konstantinos P Letsas, Loukas K Pappas, Gerasimos Gavrielatos

    International Journal of Cardiology
    |October 20, 2006
    PubMed

    Insights

    Transient coronary artery ischemia can occur during atrial fibrillation ablation. This complication, presenting as chest discomfort, resolved with nitrates and may involve vagal nerve activation.

    Area of Science:

    • Cardiology
    • Interventional Electrophysiology

    Background:

    • Radiofrequency catheter ablation is a common treatment for atrial fibrillation.
    • Transseptal puncture is a critical step in atrial fibrillation ablation procedures.

    Observation:

    • Two cases of transient coronary artery ischemia were observed during transseptal procedures.
    • Patients experienced chest discomfort with ST-segment elevation in inferior leads.

    Findings:

    • The ischemia resolved with intravenous nitrates.
    • Coronary angiography revealed normal arteries in all patients.
    • A neurally mediated pathway involving the vagal network is a potential cause of coronary artery spasm.

    Implications:

    • This suggests a potential complication of transseptal procedures that requires prompt recognition and management.
    • Understanding the underlying mechanism may help prevent future occurrences.
    • Coronary artery embolism is a distinct mechanism to consider.

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