This first reported case highlights the risk of acute right coronary artery occlusion during radiofrequency ablation of typical atrial flutter in patients with severe upstream coronary stenosis.
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Raises caution for RCA occlusion during flutter ablation with proximal stenosis; leaves open optimal prevention strategies.
We report the first case of acute right coronary artery occlusion in an adult patient during radiofrequency catheter ablation of typical atrial flutter. ST segment elevation rapidly resolved with antithrombotic therapy. This complication was thought to be due to the short distance between the endocardium and the right coronary artery at the ablation site, the high-wattage output from the radiofrequency generator, and the lack of sufficient cooling effect related to a severe upstream coronary stenosis. In patients with known right coronary artery stenosis who are suffering from typical atrial flutter, evaluation of the significance of the stenosis would be reasonable.
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Ouali et al. (2002) studied this question.
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