Transient ST-segment elevation during transseptal catheterization for atrial fibrillation ablation
Bao H Le1, James N Black, Shoei K Stephen Huang
1Section of Cardiac Electrophysiology & Pacing, Division of Cardiology, Department of Internal Medicine, Scott & White Memorial Hospital, Texas A&M University Health Science Center, Temple, Texas 76508, USA.
Texas Heart Institute Journal
|January 13, 2011
Summary
Unexpected ST-segment elevation during transseptal catheterization for atrial fibrillation ablation may be caused by autonomic imbalance or air embolism. Careful monitoring is advised if transient and without myocardial infarction evidence.
Area of Science:
- Cardiology
- Electrophysiology
- Interventional Cardiology
Background:
- Transseptal catheterization is crucial for treating refractory left atrial tachyarrhythmias like atrial fibrillation.
- Procedures aim for pulmonary vein isolation and left atrial substrate ablation.
Observation:
- An unexpected ST-segment elevation occurred in a 71-year-old male during Brockenbrough transseptal catheterization.
- Immediate coronary angiography revealed normal findings.
Findings:
- The study hypothesizes autonomic imbalance due to manipulation of cardiac autonomic nerves, causing coronary artery spasm and ST elevation.
- Coronary artery air embolism is a potential differential diagnosis.
Implications:
- Transient ST elevation without acute myocardial infarction may warrant monitoring over immediate procedure termination.
- Understanding the pathophysiology aids in managing this rare electrocardiographic phenomenon.
Keywords:
Atrial fibrillation/complications/epidemiology/etiology/physiopathology/therapybradycardia/etiologycatheter ablation/adverse effects/methodscoronary angiographycoronary vasospasm/physiopathologydiagnosis, differentialelectrocardiographyhypotension/etiologyintraoperative complications/etiologypulmonary veins/surgery
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