J Korean Med Sci.  2014 Feb;29(2):292-295. 10.3346/jkms.2014.29.2.292.

Acute Myocardial Infarction after Radiofrequency Catheter Ablation of Typical Atrial Flutter

• Yune S
• Lee WJ
• Hwang JW
• Kim E
• Ha JM
• Kim JS

• KMID: 1789991
• DOI: http://doi.org/10.3346/jkms.2014.29.2.292

Abstract

A 53-yr-old man underwent radiofrequency ablation to treat persistent atrial flutter. After the procedure, the chest pain was getting worse, and the electrocardiogram showed ST-segment elevation in inferior leads with reciprocal changes. Immediate coronary angiography showed total occlusion with thrombi at the distal portion of the right coronary artery, which was very close to the ablation site. Intervention with thrombus aspiration and balloon dilatation was successful, and the patient recovered without any kind of sequelae. Although the exact mechanism is obscure, the most likely explanation is a thermal injury to the vascular wall that ruptured into the lumen and formed thrombus. Vasospasm and thromboembolism can also be other possibilities. This case raise the alarm to cardiologists who perform radiofrequency ablation to treat various kinds of cardiac arrhythmias, in that myocardial infarction has been rarely considered one of the complications.

Keyword

Atrial Flutter; Catheter Ablation; Myocardial Infarction

MeSH Terms

Acute Disease
Angioplasty, Balloon, Coronary
Atrial Flutter/*surgery
Catheter Ablation/*adverse effects
Chest Pain/etiology
Coronary Occlusion/etiology
Coronary Vessels/radiography
Humans
Male
Middle Aged
Myocardial Infarction/*diagnosis/etiology/therapy
Thrombosis/surgery

Figure

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  Fig. 1 Resting electrocardiography showed typical atrial flutter with 2:1 or 3:1 conduction before the radiofrequency ablation.

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  Fig. 2 Ablation of atrial flutter. (A) The fluoroscopic image, left anterior oblique, showing the position of ablation and diagnostic catheters. (B) Intracardiac electrogram showing typical counterclockwise atrial flutter. ABL, ablation; HIS, His bundle; CS, coronary sinus; RVA, right ventricular apex.

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  Fig. 3 Electrocardiograms. (A) Right after the radiofrequency ablation. Elevation of ST-segment in lead II, III, aVF and reciprocal change in the anterior precordial leads are noted. (B) After an hour of the primary coronary intervention. Previous ST-T changes disappeared.

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  Fig. 4 Acute occlusion of right coronary artery. (A) Coronary angiography, right anterior oblique, showing total occlusion of at the distal portion of right coronary artery (arrow). (B) Revascularization after balloon angioplasty with resultant 20% residual stenosis. (C) The fluoroscopic image, left anterior oblique, showing the position of ablation catheter tip during radiofrequency ablation (arrow).

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