Radiofrequency ablation of typical atrial flutter using a septal or lateral approach can result in right coronary artery occlusion near the ablative lesions.
Case Report (n=2)
Highlights the rare but serious risk of right coronary artery occlusion during septal or lateral radiofrequency ablation of typical atrial flutter, emphasizing the need for careful catheter positioning and energy titration.
Right coronary artery (RCA) occlusion and acute myocardial infarction are rare during radiofrequency (RF) ablation of the cavotricuspid isthmus. Ventricular fibrillation (VF) or cardiac arrest in the periprocedural period may be the initial or only clinical manifestation. Septal or lateral RF delivery may increase the risk. We report 2 cases of RCA occlusion during ablation of typical atrial flutter (AFL). Angiographic and anatomical correlations are illustrated. One patient was ablated with a septal approach, the other with a lateral approach, and in each instance the RCA occluded near the ablative lesions. If septal or lateral ablation lines are contemplated during ablation of isthmus-dependent atrial flutter, fluoroscopic or electroanatomic confirmation of catheter position is pivotal. Smaller tipped catheters, energy titration (to minimally effective dose), saline irrigation, or cryoablation should also be considered to help avoid this serious complication.
Mykytsey et al. (Mon,) conducted a case report in Typical atrial flutter (n=2). Radiofrequency ablation of the cavotricuspid isthmus was evaluated on Right coronary artery occlusion. Radiofrequency ablation of typical atrial flutter using a septal or lateral approach can result in right coronary artery occlusion near the ablative lesions.