Intramyocardial Hematoma During Catheter Ablation for Scar-Related Ventricular Tachycardia
Roy M John1, Usha Tedrow2, Thomas Tadros2
1Stanford University, Palo Alto, California, USA.
Insights
Intramural hematoma is a rare, dangerous complication during ablation for scar-related ventricular tachycardia (VT). Prompt recognition and surgical intervention are often life-saving for this VT ablation complication.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Complications
Background:
- Intramural hematoma is a rare but life-threatening complication during ablation procedures for scar-related ventricular tachycardia (VT).
- Understanding the characteristics and outcomes of this complication is crucial for patient safety.
Purpose of the Study:
- To describe the features and outcomes of intramural hematoma occurring during ablation for scar-related VT.
- To identify patterns and risk factors associated with this rare complication.
Main Methods:
- Retrospective review of >3,514 VT ablations performed between 2010 and 2022 at two institutions.
- Analysis of intraprocedural details, imaging data, and surgical notes for four identified cases of intramural hematoma.
- Correlation of procedural events, such as steam pops and catheter types, with hematoma formation.
Main Results:
- Intramural hematoma occurred during catheter ablation in 3 of 4 cases, often preceded by a steam pop.
- ST-segment elevation and intracardiac echocardiographic findings were key diagnostic indicators.
- Pericardial effusion requiring drainage occurred in 3 cases; surgical intervention was successful in 2 cases, but one patient died from cardiogenic shock.
Conclusions:
- Intramural hematoma during VT ablation is a rare, potentially catastrophic complication requiring prompt recognition.
- Steam pops are frequent precursors to hematoma formation.
- Surgical intervention can be life-saving, though conservative management is possible for contained hematomas.
Background:
Intramural hematoma during ablation for scar-related ventricular tachycardia (VT) is a rare but life-threatening complication.
Objectives:
The goal of this study was to describe the features and outcomes of intramural hematoma during ablation for scar-related VT.
Methods:
From 2010 to 2022, >3,514 ablations for ventricular arrhythmias were performed at 2 institutions. Four cases of intramural hematoma complicating VT ablation for scar-related VT were identified. Intraprocedural details, imaging data, and surgical notes were reviewed to create a recognizable pattern of events highlighting this complication.
Results:
In 3 of 4 cases, intramural hematoma occurred during catheter ablation with an open irrigated 3.5 mm tipped catheter using normal saline for irrigation. In one case, hematoma was noted after ablation using an investigational needle electrode catheter. The occurrence of a steam pop preceded detection of an expanding intramural hematoma in 3 cases. ST-segment elevation on electrocardiography was evident in 3 cases; intracardiac echocardiographic imaging detected the hematoma in all cases. Epicardial rupture and pericardial effusion requiring drainage occurred in 3 cases, whereas 1 hematoma was self-contained and did not require intervention. Surgical intervention was performed in 2 cases, with successful outcomes. One patient who was deemed not a surgical candidate died of progressive cardiogenic shock.
Conclusions:
Intramural hematoma during ablation for scar-related VT is a rare but potentially catastrophic complication that requires prompt recognition. Steam pops during ablation frequently precede the hematoma formation. Surgical intervention may be life-saving, although contained hematomas can occasionally be managed conservatively.
Related Concept Videos
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:21Cardiac Catheterization II: Right Heart Catheterization
01:28Disturbances in Heart Rhythm
Arrhythmias are categorized by their speed, rhythm, and origin. A slow...