Case report describes ST-segment elevation myocardial infarction in a patient with atrial flutter, suggesting potential risks during catheter ablation in coronary sinus branches.
The risk of ablation-induced coronary artery injury is low, but may increase with the anatomic proximity and increasing frequencies of redo procedures or when catheter ablation is performed in the coronary sinus branches. We present the case of a 53-year-old woman with a history of 5 ablations over the past 12 years. Owing to recurrence of highly symptomatic atrial flutter, a repeat ablation was performed in the coronary sinus. She developed chest pain accompanied by ST-segment elevation in the inferior leads. Coronary angiography demonstrated an occluded mid-circumflex artery, which we believe was induced by direct thermal injury. This was successfully treated with a drug-eluting stent.
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Saeed et al. (2025) studied this question.
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