Bizarre electrocardiographic changes during occlusion of a congenital coronary arteriovenous fistula

Area of Science:

• Cardiology
• Interventional Cardiology
• Diagnostic Electrocardiography

Background:

• Coronary arteriovenous fistulas (CAVF) are rare congenital or acquired abnormalities.
• Percutaneous coil occlusion is a common treatment for CAVF, but complications can arise.
• This case involves a patient with a history of prior coil occlusion for a persistent CAVF.

Observation:

• The patient presented with typical chest pain and shortness of breath.
• Exercise stress testing revealed ST depressions.
• Coronary angiography confirmed a persistent CAVF with existing coils, necessitating further intervention.

Findings:

• Attempted additional coil placement and detachment within the fistula failed after multiple trials.
• During attempted electrical detachment, unusual and bizarre ST segment changes were observed on electrocardiogram (ECG).
• Successful treatment was achieved by deploying a graft stent across the fistula.

Implications:

• This case highlights the potential for unexpected and severe electrocardiographic changes during interventional procedures for coronary arteriovenous fistulas.
• The findings underscore the importance of careful monitoring and awareness of rare complications during coil embolization and detachment.
• Management of persistent or complex CAVF may require alternative strategies like stent-graft deployment when standard coil embolization fails.