Left Atrial Intramural Hematoma Post-Ablation of Supraventricular Tachycardia

Abstract

We report successful management of left atrial hematoma after ablation of supraventricular tachycardia. A 43-year-old female patient experienced chest pain immediately after radiofrequency ablation of a symptomatic left posterolateral accessory pathway. Transthoracic echocardiography demonstrated a large mass occupying the left atrium. Computed tomography and transesophageal echocardiography results were consistent with posterolateral intramural hematoma. She became hemodynamically unstable, requiring emergent surgery. The mass resolved completely by 6 weeks. ( Level of Difficulty: Beginner. )

Left atrial ıntramural hematoma after radiofrequency catheter ablation of left lateral accessory pathway

“…Myung-jin Cha and Seil Oh reported a case of patient with an intramural hematoma associated with RFCA for intractable atrial tachyarrhythmias, who was treated with surgery [4]. The first case of LAIH as a complication of left posterolateral concealed accessory pathway ablation using retrograde aortic approach reported by Giudicatti et al [5]. Similarly, our case has a LAIH as a complication of left lateral concealed accessory pathway RF ablation too.…”

Left Atrial Intramural Hematoma After Radiofrequency Catheter Ablation

“…The case described by Giudicatti et al. ( 14 ) provides valuable insights into the management of a rare complication post-RFCA and highlights the usefulness of a hemodynamically based approach in managing this potentially life-threatening complication.…”

“…In this issue of JACC: Case Reports, Giudicatti et al. ( 14 ) present the case of a 43-year-old woman who experienced pleuritic chest pain immediately following RFCA of a symptomatic left posterolateral accessory pathway. Transthoracic echocardiography demonstrated a large mass, almost entirely occupying the left atrium.…”

“…( 14 ) postulate that mechanical trauma to the lateral and posterior mitral annulus may have resulted in epicardial and endocardial separation of the left atrium that created a dissection flap. It is worthwhile to note that accessory pathway ablation, as performed in the present case ( 14 ), focuses on a small segment of the mitral annulus as compared with atrial fibrillation ablation, which may be associated with higher thermal energy and increased manipulation of the LA walls. To avoid such complications, TEE or intracardiac echocardiography can be used to guide the ablation procedure.…”

“…As highlighted by Giudicatti et al. ( 14 ), a multimodal imaging approach can be extremely valuable in the noninvasive evaluation of an unidentified LA mass. A presumptive diagnosis can be made on the basis of transthoracic echocardiography, TEE, CT, and cardiac magnetic resonance.…”