ST-Segment Elevation Associated with Mobitz II Atrioventricular Block During Transseptal Puncture for Atrial Fibrillation Ablation
Pulmonary veins electrical isolation as an invasive treatment of atrial fibrillation has been widely used in electrophysiology laboratories. This case report presents a rare and transient complication, during transseptal puncture for atrial fibrillation ablation. ST-segment elevation, hypotension and bradyarrhythmia related to catheterization were observed despite cineangiocoronariography without obstructive lesions. Clinical stability was achieved after administration of intravenous atropine and saline solution. It is speculated that the phenomenon is attributed to an increased vagal tone after the mechanical effect of transseptal puncture in the interatrial vagal network. The procedure was completed despite the phenomenon.
Haegeli LM, Wolber T, Ercin E, Altwegg L, Krasniqi N, Novak PG, et al. Double transseptal puncture for catheter ablation of atrial fibrillation: Safety of the technique and its use in the outpatient setting. Cardiol Res Pract 2010;1. https://doi.org/10.4061/2010/295297.
Glowniak A, Tarkowski A, Jaroszyńska A, Jankiewicz M, Wysokiński A. Transient symptomatic ST-segment elevation following transseptal puncture for pulmonary vein isolation. Prog Med 2015;8:567–9.
Arita T, Kubota S, Okamoto K, Kuma F, Nakasuga K, Koga H, et al. Bezold-Jarisch-like reflex during Brockenbrough’s procedure for radiofrequency catheter ablation of focal left atrial fibrillation: Report of two cases. J Interv Card Electrophysiol 2003;8:195–202. https://doi.org/10.1023/A:1023917221763.
Cheng YL, Dong JZ, Liu XP, Long DY, Fang DP, Yu RH, et al. Transient ST-segment elevation after transseptal puncture for atrial fibrillation ablation in two cases. Chin Med J (Engl) 2012;125:941–4. https://doi.org/10.3760/cma.j.issn.0366-6999.2012.05.037.
Simon RDB, Gill JS. Coronary ischemia induced by radiofrequency ablation in the left atrium. J Cardiovasc Electrophysiol 2003;14:186–90. https://doi.org/10.1046/j.1540-8167.2003.02474.x.
Tang RB, Dong JZ, Long DY, Yu RH, Liu XP, Cheng YL, et al. Incidence and clinical characteristics of transient ST-T elevation during transseptal catheterization for atrial fibrillation ablation. Europace 2015;17:579–83. https://doi.org/10.1093/europace/euu278.
Le BH, Black JN, Stephen Hung SK. Transient ST-segment elevation during transseptal catheterization for atrial fibrillation ablation. Texas Hear Inst J 2010;37:717–21.
Campagna JA, Carter C. Clinical relevance of the Bezold-Jarisch reflex. Anesthesiology 2003;98:1250– 60. https://doi.org/10.1097/00000542-200305000-00030.
Ishigaki D, Arimoto T, Iwayama T, Kutsuzawa D, Yashiro Y, Nitobe J, et al. ST-segment elevation and ventricular fibrillation shortly after transseptal puncture for left atrial catheter ablation. J Arrhythmia 2013;29:296–9. https://doi.org/10.1016/j.joa.2013.03.004.
Efremidis M, Letsas KP, Xydonas S, Koutras K, Sideris A, Kardaras F. ECG findings of acute myocardial infarction and atrioventricular block during a transseptal procedure for left atrial ablation. Hell J Cardiol 2008;49:284–7.
Risius T, Lewalter T, Lüderitz B, Schwab JO, Spitzer S, Schmitt C, et al. Transient ST-segment elevation during pulmonary vein ablation using circumferential coiled microelectrodes in a prospective multi-centre study. Europace 2006;8:178–81. https://doi.org/10.1093/europace/euj013.