An abnormal left ventricular-atrial perforation after radiofrequency catheter ablation: a case report

Tao, Tingting; Zheng, Jianbo; Xu, Hongfei; Ni, Yiming

doi:10.1186/s13019-019-1011-y

Cited by 3 publications

(1 citation statement)

References 8 publications

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“…A surgeon was on standby in the event that the TEE showed perforation that required repair, but this did not happen in our patient. In the majority of patients that develop acute cardiac tamponade following RFCA, emergency pericardiocentesis is sufficient for complete recovery, but an urgent surgical repair may be lifesaving in 15-20% of the cases; raising the question of the safety of the procedure performed without in-house surgical backup [ 18 , 19 ]. In addition to emergency pericardiocentesis, blood was transfused, positive inotropes, and IV fluids were given to hemodynamically stabilize our patient.…”

Section: Discussionmentioning

confidence: 99%

Acute Cardiac Tamponade as a Complication of Pulmonary Vein Isolation Ablation

Tsai¹,

Chishinga²,

Mannil³

et al. 2021

Cureus

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Perioperative acute cardiac tamponade associated with perforation from pulmonary vein isolation (PVI) and radiofrequency catheter ablation (RFCA) for the treatment of refractory atrial fibrillation (AF) is rare. If not identified early and managed promptly, it can lead to decreased ejection fraction, hypotension, and ultimately death. We report a case of acute tamponade that was diagnosed and successfully managed following PVI and RFCA. A 49-year-old woman with a past medical history of paroxysmal AF and sick sinus syndrome presented to our hospital with intermittent episodes of palpitations and recurrent episodes of syncope. Given the drug-refractory AF, our patient underwent PVI and RFCA. A loop recorder was implanted for recurrent episodes of syncope, which revealed that she had sick sinus syndrome. During the current visit, transthoracic ECG revealed mild tricuspid regurgitation and trace pericardial effusion. Her left ventricle (LV) ejection fraction was 60%. A CT angiography of the pulmonary vessels and the aorta showed no evidence of pulmonary embolism, aortic aneurysm, or aortic dissection. However, there was an enlarged heart size and small bilateral pleural effusions. During a second PVI and RFCA, while in the operating room, the patient became hypotensive. A transesophageal echocardiogram (TEE) showed diastolic volume reduction in the right atrium and right ventricular and pericardial effusion. Intravenous (IV) resuscitation with lactated Ringer's solution and saline solution was rapidly given to the patient while performing percutaneous pericardiocentesis. In addition, packed red blood cells were transfused into the patient, and phenylephrine was given IV. There was 400 mL of blood drained from the pericardial sac, confirming the presence of acute cardiac tamponade. Following the pericardiocentesis, the patient became normotensive. A drainage tube was inserted into the pericardial space, which drained a total of 250 mL of sanguineous fluid over the next 48 hours after the procedure, after which it was removed without signs of persistent bleeding, and the patient was discharged. We conclude that her previous PVI and RFCA, and the anatomical distortion that might have resulted from her enlarged heart size, may have predisposed her to perforation and thus acute cardiac tamponade in this PVI and RFCA. Although perforation leading cardiac tamponade is rare during PVI and RFCA, the future focus when performing this procedure should be to (i) have a high index of suspicion for acute cardiac tamponade, (ii) use TEE and intracardiac echocardiography for early detection, and (iii) promptly manage the acute cardiac tamponade with pericardiocentesis, while giving IV fluid resuscitation and positive inotropes to hemodynamically stabilize the patient.

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Section: Discussionmentioning

confidence: 99%

Acute Cardiac Tamponade as a Complication of Pulmonary Vein Isolation Ablation

Tsai¹,

Chishinga²,

Mannil³

et al. 2021

Cureus

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Interventional closure in the treatment of cardiac cavity perforation caused by pericardial puncture: a case report

Sun,

Han,

Kang

2024

J Int Med Res

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Interventional treatment for left ventricular free wall or apex perforation is rarely reported. This current case report describes a male patient in his 70 s with left ventricular perforation caused by pericardiocentesis that was successfully treated through interventional means. The patient was admitted to the hospital due to chest pain accompanied by asthmatic breathing difficulties that had lasted for the previous 10 h. Two years previously, the patient had a history of thymoma, during which pericardial effusion was discovered, leading to multiple hospitalizations for pericardial fluid aspiration. On the 10th day of admission, a chest computed tomography scan confirmed iatrogenic left ventricular apical perforation and haemorrhagic anaemia, after which interventional transcatheter left ventricular perforation sealing was performed. Postoperatively, the patient was conscious, with stable vital signs and no particular discomfort. The successful implementation of this interventional procedure suggests a new minimally invasive solution for treating left ventricular perforation caused by pericardiocentesis or interventional catheterization.

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Computer Simulation of Catheter Cryoablation for Pulmonary Vein Isolation

Rivera,

Bernal,

Martínez-Peláez

et al. 2024

Healthcare

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Cryoablation is a well-established medical procedure for surgically treating atrial fibrillation. Cryothermal catheter therapy induces cellular necrosis by freezing the insides of pulmonary veins, with the goal of disrupting abnormal electrical heart signals. Nevertheless, tissue damage induced by cold temperatures may also lead to other complications after cardiac surgery. In this sense, the simulation of catheter ablation can provide safer environments for training and the performance of cryotherapy interventions. Therefore, in this paper, we propose a novel approach to help better understand how temperature rates can affect this procedure by using computer tools to develop a simulation framework to predict lesion size and determine optimal temperature conditions for reducing the risk of major complications. The results showed that a temperature profile of around −40 °C caused less penetration, reduced necrotic damage, and smaller lesion size in the tissue. Instead, cryotherapy close to −60 °C achieved a greater depth of temperature flow inside the tissue and a larger cross-section area of the lesion. With further development and validation, the framework could represent a cost-effective strategy for providing personalized modeling, better planning of cryocatheter-based treatment, and preventing surgical complications.

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An abnormal left ventricular-atrial perforation after radiofrequency catheter ablation: a case report

Cited by 3 publications

References 8 publications

Acute Cardiac Tamponade as a Complication of Pulmonary Vein Isolation Ablation

Acute Cardiac Tamponade as a Complication of Pulmonary Vein Isolation Ablation

Interventional closure in the treatment of cardiac cavity perforation caused by pericardial puncture: a case report

Computer Simulation of Catheter Cryoablation for Pulmonary Vein Isolation

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