Key result
Radiofrequency ablation of the atrioventricular junction led to sudden cardiac arrest 7 hours post-procedure due to progressive QT interval prolongation and torsade de pointes.
Case Report (n=1)
Demonstrates the risk of repolarization instability and torsade de pointes following AV junction ablation, supporting the practice of programming a relatively rapid ventricular rate in the first weeks post-procedure.
Alerts to torsades risk from QT prolongation post-AV junction ablation; leaves open ideal initial pacing rates.
We present a case of sudden cardiac arrest 7 hours after radiofrequency ablation of the atrioventricular junction for symptomatic permanent atrial fibrillation unresponsive to medical therapy. The Holter monitoring revealed a progressive increasing of QT interval after the procedure, highlighting the repolarization instability after acute changes in heart rates associated with modification of ventricular activation, leading to occurrence of short coupling interval ventricular extra beats and finally to a "torsade de pointes." This illustration underlines the need to program a relatively rapid ventricular rate first weeks after junction ablation, especially in case of rapid ventricular rate prior to the procedure, as well as the role of continuous ECG and QT interval monitoring during hospital stay.
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Waldmann et al. (2017) conducted a case report in Symptomatic permanent atrial fibrillation (n=1). Radiofrequency ablation of the atrioventricular junction was evaluated on Sudden cardiac arrest. Radiofrequency ablation of the atrioventricular junction led to sudden cardiac arrest 7 hours post-procedure due to progressive QT interval prolongation and torsade de pointes.
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