Right coronary artery occlusion after radiofrequency catheter ablation of a posteroseptal accessory pathway: Lessons to avoid it

Figures

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  Figure 1. Fluoroscopy and electrograms at the site of radiofrequency (RF) applications. A,B: Left anterior oblique (LAO) views of the catheters (upper left: high right atrium [HRA]; lowermost: right ventricle [RV]; upper right: His; coming from top to the bottom: mapping catheter) during catheter mapping inside the coronary sinus (CS) (A) and near the CS ostium (B). C, D: Electrograms with continuous AV signals (C), and interruption of the accessory pathway (AP) conduction during RF application (D). E, F: Electrocardiogram immediately after (E) and 30 minutes after AP ablation (F) are shown. Minor ST-T changes are visualized that could be explained by cardiac memory after AP ablation or intermittent right coronary artery spasm

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  Figure 2. Electrocardiogram (ECG) during chest pain and coronary angiography showing distal right coronary artery (RCA) occlusion. A: ECG shows an inferior wall (leads II, III, and aVF) ST-segment elevation acute myocardial infarction, together with q waves. B: Right coronary angiography showing distal RCA occlusion at the level of the crux cordis. Note the negative image suggestive of a thrombus. C: A 0.014-inch guidewire and RCA angioplasty with a stent.

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  Figure 3. A: Coronary computed tomography angiography showing the relationship between the stent placed and right atrial wall. Note that the distance may be as short as 2.7 mm at the lateral tricuspid annulus (TA) to 5.7 mm at the septal TA. B: Magnetic resonance imaging with 3D reconstruction after 3 days of angioplasty showing left ventricle (LV) inferior basal scar derived from the ST-segment elevation acute myocardial infarction. Note the right coronary artery shown in light red, the stent shown in white, and the scar shown in dark red over the LV surface in dark blue.