Aberrant coronary artery spasms cause ST-T segment depression during endovascular ablation of atrial flutter
Eva A H Lanters1, Adriaan Coenen1,2, Marisa M Lubbers1,2
1Department of Cardiology Erasmus Medical Center Rotterdam Rotterdam The Netherlands.
Clinical Case Reports
|August 8, 2017
Insights
ST-T segment depression during catheter ablation can be caused by coronary artery spasms, not just blockages or rapid heart rates. This is particularly relevant in patients with unusual coronary anatomy.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Electrophysiology
Background:
- ST-T segment depression during cardiac procedures can indicate myocardial ischemia.
- Common causes include obstructive coronary artery disease and tachycardia-induced ischemia.
- Right-sided endovascular catheter ablation is a common electrophysiology procedure.
Observation:
- ST-T segment depression was observed during right-sided endovascular catheter ablation.
- This occurred in patients without obstructive coronary artery disease or significant tachycardia.
- The phenomenon was linked to catheter manipulation near coronary arteries.
Findings:
- Coronary artery spasm is a potential cause of ST-T segment depression during ablation.
- Catheter manipulation can evoke spasms, especially in anatomically variant coronary arteries.
- This finding expands the differential diagnosis beyond obstructive disease and tachycardia.
Implications:
- Clinicians performing catheter ablation should consider coronary artery spasm as a cause of ischemic changes.
- Awareness is crucial for patients with abnormal coronary artery anatomy.
- This may prompt alternative diagnostic or management strategies to prevent adverse cardiac events.
Abstract:
ST-T segment depression during right-sided endovascular catheter ablation is not only caused by obstructive coronary artery disease or (induced) tachycardia. Clinicians should also consider coronary artery spasms evoked by manipulation of nearby catheters, especially in patients with abnormal coronary artery anatomy.
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