Key result
Radiofrequency ablation of a concealed left free wall accessory pathway induced a sudden, self-resolving 13.2-second period of asystole that did not affect the success of the procedure.
Case Report (n=1)
No
Sudden prolonged asystole is a rare, self-resolving complication of radiofrequency ablation likely due to vagal response, which does not preclude procedural success.
Answers are grounded in this paper and cite their sources.
Operators should anticipate rare transient asystole during left free-wall pathway ablation; single-case report leaves incidence and prevention open.
BACKGROUND: Radiofrequency (RF) ablation is a widely accepted and ideal therapeutic tool to cure some tachycardias. The occurrence of complications varies depending on the procedure being performed. Sudden unexpected prolonged asystole is rare for most ablation procedures and the underlying mechanisms remain unclear. CASE PRESENTATION: A case of sudden prolonged asystole induced by RF ablation of a concealed left free wall accessory in a 59-year-old woman with recurrent tachycardia. RF application provoked progressive slowing of the sinus rhythm and then a 13.2-second period of asystole ensued. Asystole was self-healing and no complications were seen in the following follow-up. CONCLUSIONS: RF ablation may develop prolonged asystole due to vagus response caused by stimulation of unmyelinated vagal C-fibers or ganglionated plexus (GP). Reflexible asystole is reproducible and resolves independently, without affecting the procedure of RF ablation.
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Hu et al. (2014) conducted a case report in Paroxysmal supraventricular tachycardia (AV re-entrant tachycardia) (n=1). Radiofrequency ablation was evaluated on Occurrence of sudden cardiac asystole during ablation. Radiofrequency ablation of a concealed left free wall accessory pathway induced a sudden, self-resolving 13.2-second period of asystole that did not affect the success of the procedure.
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