Case report: Managing profound circulatory collapse post-atrial fibrillation ablation: a methodical approach

Area of Science:

• Cardiology
• Electrophysiology
• Interventional Cardiology

Background:

• Circulatory collapse post-pulmonary vein (PV) isolation via cryo-balloon ablation is a critical cardiology emergency.
• Potential causes include cardiac tamponade, bleeding, anaphylaxis, pulmonary embolism, and vagal reactions.

Purpose of the Study:

• To present a case of profound circulatory collapse during cryo-balloon ablation for atrial fibrillation.
• To emphasize the methodical exclusion of potential complications and management strategies.

Main Methods:

• A case report of a 76-year-old female undergoing elective pulmonary vein isolation for paroxysmal atrial fibrillation (AF).
• Exclusion of cardiac tamponade, bleeding, and other less common causes of collapse.
• Management involved fluid resuscitation, isoprenaline for bradyarrhythmias and hypotension.

Main Results:

• The patient experienced profound circulatory collapse during the procedure.
• Other common complications were ruled out.
• Intermittent bradyarrhythmias and hypotension responded to isoprenaline.
• The patient recovered and was discharged on Day 3 post-ablation.

Conclusions:

• Circulatory collapse during PV cryo-balloon ablation necessitates a systematic approach to identify the cause.
• A persistent vagal reaction, potentially linked to autonomic nervous system modulation, can occur.
• Management of vagal reactions with supportive medical therapy, as demonstrated, can be effective.