Incidence and characteristics of transient St-segment elevation during transseptal puncture

Fatal coronary artery spasm triggered before transseptal puncture for mitral transcatheter edge-to-edge-repair: a case report

“…Most cases occur after transseptal puncture, while some occur after the ablation procedure. 1 , 6 In our case, the patient experienced bradycardia and hypotension before the catheter entered the LA during the process of manipulation in the atrial septum, and ‘tenting’. The forward tension by the sheath on the foramen ovale for ‘tenting’ that even before crossing the septum can trigger the nerve complexes and cause a Bezold–Jarisch-like reflex.…”

“…Tang et al 6 reported that the incidence rate of STE during transseptal catheterization for atrial fibrillation ablation was about 0.38%. However, Vale et al 1 showed that the rate was 1.3% in a retrospective cohort and 5.2% in a prospective cohort. Another study found that the phenomenon of STE occurred mostly after transseptal puncture, even after ablation.…”

“…Transient ST-segment elevation (STE) or coronary artery spasm is a rare complication that occurs during transseptal catheterization. 1 But, persistent STE and multiple coronary artery spasms could prove fatal. 2 We present a case of life-threatening multiple coronary artery spasms with advanced atrioventricular block and ventricular fibrillation during compression of the fossa ovalis by a sheath catheter, before the performance of the transseptal puncture procedure for mitral TEER.…”