Manifestations of coronary arterial injury during catheter ablation of atrial fibrillation and related arrhythmias

Anatomy of the left main coronary artery of particular relevance to ablation of left atrial and outflow tract arrhythmias

“…20,21 Although there have been no cases of LMCA injury during LA ablation, a recent report described proximal Cx injury from 35 W of RF energy to the anterior LA during AF ablation. 22 If CTCA before AF RF ablation demonstrates a close relationship between the LMCA and anterior LA, or if such imaging is not performed, RF ablation should be applied cautiously with reduced power and duration. The anterior LA myocardium is relatively thin (2.6 mm), and long duration or high power should not be needed to achieve transmural necrosis.…”

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…In the above series, five of the eight patients presented with acute sinus node dysfunction. 1233 In most of these cases, the culprit site was adjacent to the sinus node artery (per CT) at the anterior LA or septal RA. All these cases presented with sinus arrest during or within 1 hour of ablation and with no evidence of any other electrocardiographic changes associated with coronary occlusion.…”

“…In a consecutive series of 5709 patients undergoing ablation of AF, coronary arterial injury was observed to occur in eight patients (0.14%). 1233 …”

“…Occlusion of the circumflex accounted for three of the eight cases in the above series, all presenting with ventricular fibrillation 20 and 60 minutes after mitral isthmus ablation and 6 hours after ablation at the LAA base, respectively. 1233 Others have also described features of acute myocardial infarction with ST segment changes occurring during ablation at the mitral isthmus. 923 These patients have variably undergone unsuccessful intracoronary vasodilators or thrombectomy and have had to progress to coronary stenting.…”

Accelerated idioventricular rhythm after left atrial tachycardia ablation as a marker of acute coronary ischemia

“…It is more common in the setting of complex left atrial ablation 3, 4. It has been reported to result in acute sinus node dysfunction requiring permanent pacing as well as ventricular fibrillation 5 and the proximity of the artery to anatomical structures was relevant to the clinical outcome when assessed in pathological specimens 6 . Wong et al 4 report acute arterial injury in 28% of patients undergoing left atrial ablation procedures.…”