Key result
LMCA injury during catheter ablation carries a ~32% in-hospital mortality rate.
Why the study?
LMCA injury is a rare but potentially fatal complication of catheter ablation, with occlusion usually presenting as a dramatic event due to its large perfusion area.
What are the clinical characteristics, management, and outcomes of left main coronary artery injury complicating catheter ablation?
Systematic Review (n=26)
What are the clinical characteristics, management, and outcomes of left main coronary artery injury complicating catheter ablation?
Left main coronary artery injury during catheter ablation is a rare but highly lethal complication (32% in-hospital mortality) that requires prompt detection and is most successfully managed with direct stenting.
Answers are grounded in this paper and cite their sources.
Requires immediate post-ablation vigilance for LMCA injury; extends case reports by systematically quantifying in-hospital outcomes.
INTRODUCTION: Left main coronary artery (LMCA) injury is a rare but potentially fatal complication of catheter ablation. Due to LMCA large perfusion area, its occlusion is usually a dramatic event. METHODS AND RESULTS: Reports of LMCA injury complicating catheter ablations from 1987 to 2018 were searched in electronic databases. Twenty-two cases of serious LMCA damage have been identified. Additionally, four reports of direct mechanical trauma involving major LMCA branches induced by inadvertent catheter insertion have been studied. Typically 86% LMCA injury presented as an acute/subacute complication of retrograde ablation in left ventricle/left ventricular outflow tract or aortic cusps. In at least 86% of patients with an in-hospital presentation, the LMCA trauma manifested dramatically as a life-threatening arrhythmia, cardiogenic shock, or severe hypotension requiring vasopressors. In-hospital mortality rate was 32%. Direct stenting has been found to be the most successful strategy. CONCLUSION: LMCA injury, even if initially asymptomatic with normal angiographic appearance, may cause delayed flow deterioration, requiring prolonged monitoring and extended follow-up. Special caution should be given to the prevention whereas survival depends on prompt detection and treatment.
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Klaudel et al. (2018) conducted a systematic review in Left main coronary artery injury during catheter ablation (n=26). Catheter ablation was evaluated on Clinical presentation and in-hospital mortality. Left main coronary artery injury during catheter ablation manifested as a life-threatening event in 86% of in-hospital presentations, with an overall in-hospital mortality rate of 32%.
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