Coronary Thrombosis Due To Atypical Mechanism during Radiofrequency Ablation: A Case Report

Roberto Ramos Barbosa, Priscila Cabral Gomes Coelho Lima, Rodolfo Costa Sylvestre, Lucas Crespo de Barros, Luiz Carlos Sartório Filho, Carlos Alexandre Volponi Lovatto, Dalbian Simões Gasparini, Christiano Lemos da Cunha, Aloyr Gonçalves Simões Junior, Fabricio Sarmento Vassallo, Luiz Fernando Machado Barbosa.

Abstract

Radiofrequency ablation is currently used for the treatment of several arrhythmias, including premature ventricular complexes (PVCs) in cases of persistent symptoms despite optimized medical treatment and arrhythmia-induced-cardiomyopathy. The most common complications are those related to the vascular access, followed by cardiac tamponade. Atrioventricular blocks, coronary lesions and neurological alterations may also occur. We report a case of a fifty-year-old female referred for catheter ablation of PVCs, who evolved with cardiac tamponade and cardiorespiratory arrest during procedure. After pericardiocentesis and return of spontaneous circulation, a persistent anterior wall ST-segment elevation was noted. Immediate coronary angiography showed occlusion of the left anterior descending artery, probably secondary to extrinsic compression by the pigtail catheter in the pericardial sac during chest compressions, a mechanism not yet described of myocardial infarction during ablation. Primary percutaneous coronary intervention was successfully performed. The patient had favorable evolution after the complications, with no ventricular dysfunction, and was discharged from hospital after seven days.