Coronary artery injury due to catheter ablation in adults: presentations and outcomes
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Coronary artery injury due to catheter ablation in adults: presentations and outcomes. / Roberts-Thomson, Kurt C; Steven, Daniel; Seiler, Jens; Inada, Keiichi; Koplan, Bruce A; Tedrow, Usha B; Epstein, Laurence M; Stevenson, William G.
in: CIRCULATION, Jahrgang 120, Nr. 15, 13.10.2009, S. 1465-1473.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Coronary artery injury due to catheter ablation in adults: presentations and outcomes
AU - Roberts-Thomson, Kurt C
AU - Steven, Daniel
AU - Seiler, Jens
AU - Inada, Keiichi
AU - Koplan, Bruce A
AU - Tedrow, Usha B
AU - Epstein, Laurence M
AU - Stevenson, William G
PY - 2009/10/13
Y1 - 2009/10/13
N2 - BACKGROUND: Currently, only anecdotal information exists on the presentation and outcome of coronary arterial injury after ablation procedures.METHODS AND RESULTS: Four patients who sustained coronary artery injury of a cohort of patients undergoing 4655 consecutive ablation procedures (0.09%) are described. The patients' mean age was 45+/-11 years, and 1.8+/-0.5 prior ablation attempts had been unsuccessful. Coronary injury occurred from epicardial ventricular tachycardia ablation in 2 patients (irrigated radiofrequency ablation in one and cryoablation in the other) and ablation within the middle cardiac vein with irrigated radiofrequency in 2 patients. All involved branches of the right coronary artery. Acute occlusion presenting with ST-segment elevation immediately after ablation was recognized during the procedure in 2 cases. Occlusion failed to respond to nitroglycerin or balloon dilation, and stenting was required in both cases. Acute myocardial infarction occurred 2 weeks after epicardial ablation as a result of occlusion of a right ventricular branch of the right coronary artery giving rise to the posterior descending coronary artery in 1 patient. A moderate asymptomatic stenosis was seen on angiography after epicardial cryoablation in 1 patient. All patients recovered and remained asymptomatic from the coronary injury and arrhythmias during 37+/-53 months of follow-up.CONCLUSIONS: Coronary arterial injury after ablation procedures is rare. It may present acutely or several weeks after an ablation procedure. Acute occlusion appears to require coronary stenting. Unanticipated anatomic variations can predispose to coronary injury.
AB - BACKGROUND: Currently, only anecdotal information exists on the presentation and outcome of coronary arterial injury after ablation procedures.METHODS AND RESULTS: Four patients who sustained coronary artery injury of a cohort of patients undergoing 4655 consecutive ablation procedures (0.09%) are described. The patients' mean age was 45+/-11 years, and 1.8+/-0.5 prior ablation attempts had been unsuccessful. Coronary injury occurred from epicardial ventricular tachycardia ablation in 2 patients (irrigated radiofrequency ablation in one and cryoablation in the other) and ablation within the middle cardiac vein with irrigated radiofrequency in 2 patients. All involved branches of the right coronary artery. Acute occlusion presenting with ST-segment elevation immediately after ablation was recognized during the procedure in 2 cases. Occlusion failed to respond to nitroglycerin or balloon dilation, and stenting was required in both cases. Acute myocardial infarction occurred 2 weeks after epicardial ablation as a result of occlusion of a right ventricular branch of the right coronary artery giving rise to the posterior descending coronary artery in 1 patient. A moderate asymptomatic stenosis was seen on angiography after epicardial cryoablation in 1 patient. All patients recovered and remained asymptomatic from the coronary injury and arrhythmias during 37+/-53 months of follow-up.CONCLUSIONS: Coronary arterial injury after ablation procedures is rare. It may present acutely or several weeks after an ablation procedure. Acute occlusion appears to require coronary stenting. Unanticipated anatomic variations can predispose to coronary injury.
KW - Adult
KW - Catheter Ablation/adverse effects
KW - Cohort Studies
KW - Coronary Angiography/methods
KW - Coronary Vessels/injuries
KW - Electrocardiography/methods
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Postoperative Complications/diagnostic imaging
KW - Treatment Outcome
U2 - 10.1161/CIRCULATIONAHA.109.870790
DO - 10.1161/CIRCULATIONAHA.109.870790
M3 - SCORING: Journal article
C2 - 19786630
VL - 120
SP - 1465
EP - 1473
JO - CIRCULATION
JF - CIRCULATION
SN - 0009-7322
IS - 15
ER -