The use of two-dimensional echocardiography during catheter ablation of the atrioventricular node

Atrioventricular nodal catheter ablation has proved an effective option in patients with drug-refractory, uncontrolled, supraventricular tachyarrhythmias; however, many complications in the immediate post ablative period relate to direct myocardial damage due to the electrical current generated by the catheter. The authors used two-dimensional echocardiography in a 57-year-old female patient with recurrent uncontrolled rapid ventricular rates despite multiple antiarrhythmic medications, in an attempt to identify the sequence of events responsible for complications of the ablation procedure. The echocardiographic images showed evidence of an explosion: microbubbles outlining an expanding force were seen which, if contained in a confined space such as the coronary sinus, might explain previously observed mechanical damage. Two-dimensional echocardiography may be useful for continual monitoring of catheter position during ablation.