ST-segment elevation and ventricular fibrillation shortly after transseptal puncture for left atrial catheter ablation

Daisuke Ishigaki, MD; Takanori Arimoto, MD; Tadateru Iwayama, MD; Kutsuzawa Daisuke, MD; Yashiro Yoshinori, MD; Nitobe Joji, MD; Aoyama Hiroshi, MD; Watanabe Tetsu, MD; Kubota Isao, MD

doi:10.1016/j.joa.2013.03.004

Journal of Arrhythmia (Oct 2013)

ST-segment elevation and ventricular fibrillation shortly after transseptal puncture for left atrial catheter ablation

Daisuke Ishigaki, MD,
Takanori Arimoto, MD,
Tadateru Iwayama, MD,
Kutsuzawa Daisuke, MD,
Yashiro Yoshinori, MD,
Nitobe Joji, MD,
Aoyama Hiroshi, MD,
Watanabe Tetsu, MD,
Kubota Isao, MD

Affiliations

Daisuke Ishigaki, MD: Department of Cardiology, Pulmonology, and Nephrology Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
Takanori Arimoto, MD: Department of Cardiology, Pulmonology, and Nephrology Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
Tadateru Iwayama, MD: Department of Cardiology, Pulmonology, and Nephrology Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
Kutsuzawa Daisuke, MD: Department of Cardiology, Pulmonology, and Nephrology Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
Yashiro Yoshinori, MD: Department of Cardiology, Pulmonology, and Nephrology Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
Nitobe Joji, MD: Department of Cardiology, Shinoda General Hospital, Yamagata, Japan
Aoyama Hiroshi, MD: Department of Cardiology, Aoyama Hospital, Kaminoyama, Japan
Watanabe Tetsu, MD: Department of Cardiology, Pulmonology, and Nephrology Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
Kubota Isao, MD: Department of Cardiology, Pulmonology, and Nephrology Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan

DOI: https://doi.org/10.1016/j.joa.2013.03.004
Journal volume & issue: Vol. 29, no. 5
pp. 296 – 299

Abstract

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A 47-year-old man with drug-resistant paroxysmal atrial fibrillation underwent left atrial (LA) catheter ablation. After sheaths were inserted into the LA using the Brockenbrough method, he complained of angina and developed ST-segment elevation in the II, III, aVF, V5, and V6 leads. Ventricular fibrillation (VF) occurred followed by ventricular tachycardia. The VF was successfully treated with direct current shock. Coronary angiography with isosorbide dinitrate showed neither spasm nor embolism in the coronary artery. The chest pain disappeared after 6 min with resolution of the ST-segment elevation. A summarized review of ST-segment elevation associated with transseptal puncture disclosed that ST-segment elevation is often found in inferior leads (87.5%), while concomitant bradyarrhythmia has been reported in 43.8% of patients. Our patient is the first recorded case with potentially lethal tachyarrhythmia. Although ST-segment elevation and VF is a rare complication associated with transseptal puncture, awareness of this complication is important.

Published in Journal of Arrhythmia

ISSN: 1880-4276 (Print); 1883-2148 (Online)
Publisher: Wiley
Country of publisher: Australia
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: https://onlinelibrary.wiley.com/journal/18832148

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