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Block of branching portion of bundle of His from catheter shaft during ablation of left ventricular outflow tract

Ayman Haq1, Ali Yousif2, Hafiza Khan2

  • 1Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas.

Proceedings (Baylor University. Medical Center)
|November 4, 2021
PubMed

Insights

Catheter ablation for ventricular premature contractions in the left ventricular outflow tract can injure the bundle of His. This case highlights a rare complication due to catheter shaft pressure, even when the ablation site is distant from the conduction system.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiac Anatomy

Background:

  • Ventricular premature contractions (VPCs) frequently originate from the left ventricular outflow tract (LVOT).
  • The atrioventricular conduction system, including the bundle of His, is anatomically situated near the aortic valve, between the noncoronary and right coronary cusps.

Observation:

  • A case involving ablation of a VPC in the LVOT, specifically below the left coronary cusp, is presented.
  • The ablation procedure resulted in an unexpected injury to the bundle of His.

Findings:

  • The injury to the bundle of His occurred despite the ablation target being anatomically remote from the conduction apparatus.
  • Mechanism of injury identified as pressure exerted by the proximal catheter shaft against the noncoronary and right coronary cusps.

Implications:

  • This case underscores a rare but significant complication of LVOT ablation.
  • Highlights the importance of meticulous catheter manipulation and awareness of anatomical proximity to prevent iatrogenic injury to the conduction system during arrhythmia ablation.

Keywords:
Atrioventricular conductionHis bundlecardiac conduction systemcatheter ablationiatrogenic injuryleft bundle branch blockright bundle branch block

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