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The risk still remains: left circumflex artery subocclusion after radiofrequency application inside the coronary

Muhieddine Omar Chokr1,2, Luan Vieira Rodrigues3, Wlademir Dos Santos Junior4

  • 1Heart Institute (Incor), University of São Paulo Medical School, São Paulo, Brazil. muhieddinechokr@hotmail.com.

Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing
|April 8, 2025
PubMed

Insights

Radiofrequency ablation inside the coronary sinus for perimitral atrial tachycardia can rarely cause circumflex artery occlusion. This case highlights the importance of procedural planning to mitigate risks during cardiac ablation procedures.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Interventional Cardiology

Background:

  • Radiofrequency (RF) ablation is used for perimitral atrial tachycardia.
  • RF energy delivery within the coronary sinus (CS) is sometimes required.
  • The CS is anatomically near the left circumflex artery (LCx), posing a potential risk.

Purpose of the Study:

  • To report a rare complication of RF ablation within the CS.
  • To discuss the potential underestimation of LCx injury risk during CS ablation.

Main Methods:

  • A case report of a 40-year-old male patient undergoing RF ablation for perimitral atrial tachycardia.
  • Radiofrequency energy applied inside the coronary sinus to create a lateral mitral block line.
  • Monitoring for immediate complications post-ablation.

Main Results:

  • The patient developed acute ST-segment elevation, indicative of myocardial infarction.
  • Successful angioplasty of the occluded circumflex artery was performed.
  • The patient showed good clinical recovery over a 30-month follow-up.

Conclusions:

  • Coronary artery injury, specifically LCx occlusion, is a rare but serious complication of RF ablation within the CS.
  • The incidence of LCx injury during CS ablation may be higher than currently recognized.
  • Meticulous procedural planning is crucial for risk mitigation, and further research is needed to eliminate this risk entirely.
Abstract

Keywords:
AblationCoronary occlusionCoronary sinusMitral isthmus blockRadiofrequency

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