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Circumflex coronary artery to left atrium fistula caused by mitral isthmus ablation

Calvin H C Hsieh1, Simon O'Connor2, David L Ross1

  • 1Westmead Hospital, Sydney, Australia.

Heart, Lung & Circulation
|April 23, 2014
PubMed

Insights

Mitral isthmus ablation for atrial fibrillation can rarely cause left circumflex artery to left atrium fistulas. This case highlights successful closure of such a fistula using a covered stent, preventing further complications.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Electrophysiology

Background:

  • Mitral isthmus ablation is a key procedure for managing persistent atrial fibrillation and specific atrial flutter types.
  • Ensuring procedural safety is paramount during catheter ablation techniques.

Observation:

  • A rare complication occurred during mitral isthmus ablation: a fistula formed between the left circumflex artery and the left atrium.
  • The patient presented with symptoms of myocardial ischemia secondary to this arteriovenous fistula.

Findings:

  • The arteriovenous fistula between the left circumflex artery and left atrium was diagnosed following the ablation procedure.
  • The symptomatic ischemia was directly attributed to the newly formed fistula.

Implications:

  • This case underscores the potential for serious vascular complications during mitral isthmus ablation.
  • Prompt diagnosis and endovascular intervention with a covered stent can effectively manage such fistulas.
  • Highlights the importance of vigilance for rare complications in electrophysiology procedures.

Keywords:
Atrial fibrillationCatheter AblationPercutaneous coronary interventionPostoperative complicationVascular fistula

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