Life‐Threatening Left Atrial Wall Hematoma Secondary to a Pulmonary Vein Laceration: An Unusual Complication of Catheter Ablation for Atrial Fibrillation

Echahidi, Najmeddine; Philippon, François; O’Hara, Gilles; Champagne, Jean

doi:10.1111/j.1540-8167.2007.01018.x

Cited by 13 publications

(8 citation statements)

References 8 publications

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“…To the present authors’ knowledge, this is the first reported case of left atrial intramural hematoma (LAIH) following ablation of a left posterolateral accessory pathway using a retrograde aortic approach. LAIH, also commonly referred to as left atrial dissection, has been most frequently associated with mitral valve repair and replacement (in more than one-half of cases) as well as post-RFA for atrial fibrillation and left atrial tachycardia ( 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ). Up to 10% of cases may occur spontaneously ( 8 ).…”

Section: Discussionmentioning

confidence: 99%

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Left Atrial Intramural Hematoma Post-Ablation of Supraventricular Tachycardia

et al. 2020

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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. )

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Section: Discussionmentioning

confidence: 99%

“…This reflects rapid expansion of the mass with occlusion of left atrial inflow and outflow. Acute and unstable presentations almost always require prompt surgical relief of the obstruction ( 2 , 5 , 7 , 8 ). In a review by Fukuhara et al.…”

Section: Discussionmentioning

confidence: 99%

Left Atrial Intramural Hematoma Post-Ablation of Supraventricular Tachycardia

et al. 2020

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“…4 Mansour et al 5 reported the entrapment of a circular mapping catheter in the left superior PV that was successfully released with the use of the ablation catheter defl ectable tip to change the vector of traction. In another case by Echahidi et al, 6 an RIPV laceration with left atrial wall hematoma and hemodynamic instability required immediate surgery.…”

Section: Discussionmentioning

confidence: 98%

Catheter Entrapment in a Pulmonary Vein

Monney

Pascale

Fromer

et al. 2010

Chest

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Ablation strategies for the treatment of atrial fibrillation (AF) are associated with several potential complications. During electro-anatomic mapping of the left atrium (LA) before ablation, the ablation catheter was entrapped in the right inferior pulmonary vein (RIPV). After multiple unsuccessful gentle tractions, stronger maneuvers with rotation of the catheter slowly allowed its retrieval. Examination of the catheter showed a thin, translucent membrane covering its tip, suggesting complete stripping of a vein branch. Occlusion of the superior branch of the RIPV was confirmed by LA angiogram. During the following days, no pericardial effusion was noted, but the patient complained of light chest pain and mild hemoptysis, spontaneously resolving within 48 h. This case shows that catheter entrapment and mechanical disruption of a PV branch can be a rare potential complication of AF ablation. In this case, the outcome was spontaneously favorable and symptoms only included transient mild hemoptysis.

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“…Echahidi reported LA dissection secondary to a pulmonary vein laceration during catheter ablation. The patient was diagnosed with systemic lupus erythematosus and chronic kidney disease and had been treated with immunosuppressive and steroid medication, which might have caused friability of LA tissue [54]. Ninomiya reported a patient who underwent double valve replacement and tricuspid annuloplasty for aortic and mitral stenosis and tricuspid regurgitation after open mitral commissurotomy 26 years ago.…”

Section: Pathogenesismentioning

confidence: 98%

Left atrial dissection

Tsukui

Iwasa

Yamazaki

2015

Gen Thorac Cardiovasc Surg

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Left atrial (LA) dissection is a rare complication and is defined as a gap from the mitral or tricuspid annular area to the interatrial septum or left atrial wall. Because of its low incidence, this entity is not fully understood. LA dissection is related to mitral valve surgery as well as coronary artery disease, arrhythmia, trauma, tumor, and spontaneous occurrence. Transesophageal echocardiography is the most useful diagnostic modality for LA dissection, but multimodality investigation supports accurate diagnosis. There are two treatment options for LA dissection: surgical repair and close observation. Surgical repair involves entry closure and internal drainage. The indication for surgery should be based on the clinical presentation.

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Life‐Threatening Left Atrial Wall Hematoma Secondary to a Pulmonary Vein Laceration: An Unusual Complication of Catheter Ablation for Atrial Fibrillation

Abstract: Left atrial wall hematoma without pericardial effusion is a rare and life-threatening complication after catheter-based AF ablation. TEE is a valuable monitoring tool to accurately diagnose several acute complications and prompt rapid intervention.

Cited by 13 publications

References 8 publications

Left Atrial Intramural Hematoma Post-Ablation of Supraventricular Tachycardia

Left Atrial Intramural Hematoma Post-Ablation of Supraventricular Tachycardia

Catheter Entrapment in a Pulmonary Vein

Left atrial dissection

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