Right coronary artery compromise following radiofrequency catheter ablation for supraventricular tachycardia: cases reports
William J Young, Sandip Vyas, Andrew Wragg, Simon Sporton, James Rosengarten, Richard J Schilling, Richard Ang- Cardiology and Cardiovascular Medicine
Abstract
Background
Coronary compromise is a serious potential complication following catheter ablation; however, procedural details in the literature are often lacking, preventing the identification of learning opportunities.
Case summary
We report two cases of right coronary compromise following catheter ablation for symptomatic supraventricular tachycardia. After radiofrequency energy delivery at the coronary sinus ostium in both cases, inferior lead ST-elevation was observed. Diagnostic coronary angiography identified an occluded posterior left ventricular branch of the coronary artery and optical coherence tomography demonstrated a high thrombus burden at this location. Electrocardiographic ST-segments settled with implantation of a drug-eluting stent.
Discussion
Coronary compromise was likely secondary to energy delivery during catheter ablation. This case series highlights the need for Electrophysiologist to understand coronary anatomy relative to anatomical landmarks, to anticipate the risk of vascular injury as physical distance from the site of ablation is likely important. Risk for coronary compromise, while a rare complication, needs to be discussed with patients during the consenting process. We also demonstrate the importance of an efficient multi-disciplinary team process to managing acute procedural complications.