Case report: diaphragmatic hernia after epicardial catheter ablation

Catheter ablation from the epicardial space is increasingly utilized to treat ventricular tachycardias (VTs). We report a rare complication.

A 67-year-old male with dilated cardiomyopathy and frequent, exercise-induced VTs had been ablated once with endocardial and twice with epicardial access. Six weeks after the last procedure, he was hospitalized with abdominal and back pain due to an iatrogenic diaphragmatic hernia with displacement of the stomach and spleen into the left thoracic cavity. Following an acute exacerbation with cardiac arrest and splenic bleeding, he underwent successful surgery with splenectomy, reposition of the stomach, and direct suture of the diaphragmatic hernia.

This is a rare complication, but notable for its delayed clinical manifestation several weeks after the procedure and necessitates urgent surgical treatment.