Thrombus Formation During Pulmonary Vein Ablation: When Routine Turns Risky

Area of Science:

• Cardiology
• Medical Imaging
• Interventional Electrophysiology

Background:

• Atrial fibrillation (AF) is a common arrhythmia linked to thromboembolic events.
• Pulmonary vein isolation is a primary treatment for AF rhythm control.
• Intraoperative transesophageal echocardiography (iTEE) aids procedural safety in AF ablation.

Purpose of the Study:

• To report a rare case of intraprocedural catheter thrombosis during AF ablation.
• To highlight the role of iTEE in detecting this complication.
• To emphasize the importance of anticoagulation management in AF ablation.

Main Methods:

• A case report of a 59-year-old male patient with paroxysmal AF undergoing redo pulmonary vein ablation.
• Utilized iTEE for procedural guidance and complication surveillance.
• Managed anticoagulation status, including interruption and subsequent uninterrupted use.

Main Results:

• iTEE identified a large thrombus on the ablation catheter after transseptal puncture due to interrupted anticoagulation.
• Procedure was postponed, and the patient recovered without complications.
• Successful redo ablation was performed 4 weeks later under uninterrupted anticoagulation.

Conclusions:

• Intraprocedural catheter thrombosis is a rare, potentially life-threatening complication of AF ablation.
• iTEE is vital for early detection and procedural guidance.
• Uninterrupted anticoagulation is essential for mitigating thromboembolic risk during AF ablation.