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Atrial Flutter Following Shockwave Intravascular Lithotripsy During Percutaneous Intervention of Left Anterior
Anthony Kechichian1, Chadi Allam1, Mario Njeim1
1Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon; Department of Cardiology, Hôtel-Dieu de France Hospital, Beirut, Lebanon.
Abstract:
A 72-year-old woman undergoing percutaneous intervention to a calcified proximal left anterior descending (LAD) coronary artery lesion using Shockwave Intravascular Lithotripsy (S-IVL) developed new atrial flutter. She then returned to sinus rhythm after treatment with amiodarone. S-IVL can cause cardiomyocyte depolarization. We hypothesize that pacing can occur during atrial repolarization, inducing supraventricular tachyarrhythmias and even triggering atrial macro re-entrant circuits. We recommend synchronizing shock wave delivery with R waves on the electrocardiogram to lower the risk of arrhythmias.
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