Regional pericarditis following uncomplicated catheter ablation procedure: a case report
Karapet V Davtyan1, Arpi H Topchyan1, Elena A Mershina2
1Department of Heart Rhythm and Conduction Disorder, National Medical Research Center for Therapy and Preventive Medicine, Petroverigskiy Lane 10-3, 101990 Moscow, Russia.
Insights
Regional pericarditis is a rare complication after catheter ablation for ventricular arrhythmias. Advanced imaging like cardiac MRI and CT aids diagnosis, especially when symptoms are atypical.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Imaging
Background:
- Acute post-ablation pericarditis is a common complication of epicardial ablation for ventricular arrhythmias.
- Regional pericarditis after endocardial catheter ablation (CA) is rare and challenging to diagnose.
Observation:
- A 66-year-old female presented with chest pain and ECG changes post-premature ventricular complex CA.
- Diagnosis was complicated by absence of fever, pericardial effusion, or myocardial abnormalities on transthoracic echocardiography (TTE).
Findings:
- The patient was diagnosed with regional pericarditis despite an uneventful CA procedure with limited radiofrequency applications.
- Cardiac magnetic resonance imaging (CMR) and cardiac computed tomography (CCT) were crucial for diagnosis.
Implications:
- Regional post-ablation pericarditis is a rare form of post-cardiac injury syndrome (PCIS).
- Diagnosis can be difficult, particularly after uncomplicated CA procedures.
- Non-invasive imaging (CMR, CCT) is recommended for elusive PCIS cases.
Background:
Acute post-ablation pericarditis is the most common complication of epicardial ablation of ventricular arrhythmias, while regional pericarditis following an initially uneventful endocardial catheter ablation (CA) procedure is a rare and elusive diagnosis.
Case Summary:
We report a case of a 66-year-old Russian female who developed chest pain accompanied by electrocardiogram (ECG) changes-biphasic T waves in V1-V4 leads after an initially uncomplicated premature ventricular complex CA procedure. After examination and investigations, including transthoracic echocardiography (TTE), cardiac magnetic resonance imaging (CMR) and cardiac computed tomography (CCT), she was diagnosed with regional pericarditis, which occurred even though the ablation was uneventful with the limited number of radiofrequency applications. Furthermore, the diagnosis was difficult due to normal body temperature and the absence of pericardial effusion and myocardial abnormalities on TTE, findings that are not characteristic of pericarditis. The patient's last office visit was in 6 months after the procedure. Neither patient had any complaintsnor there were any changes on ECG and TTE.
Discussion:
Regional post-ablation pericarditis is a relatively rare type of post-cardiac injury syndrome (PCIS). The varying severity of the PCIS clinical course makes the diagnosis of post-ablation pericarditis initially difficult, especially in patients undergoing an uneventful CA procedure. Non-invasive imaging modalities as CMR and CCT should be considered initially in elusive cases of PCIS.
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