Transseptal puncture for left atrial catheter ablation can rarely be complicated by potentially lethal tachyarrhythmias such as ventricular fibrillation associated with ST-segment elevation.
May rarely trigger VF post-transseptal puncture; leaves open incidence and prevention strategies in left atrial ablation.
A 47‐year‐old man with drug‐resistant paroxysmal atrial fibrillation underwent left atrial (LA) catheter ablation. After sheaths were inserted into the LA using the Brockenbrough method, he complained of angina and developed ST‐segment elevation in the II, III, aVF, V5, and V6 leads. Ventricular fibrillation (VF) occurred followed by ventricular tachycardia. The VF was successfully treated with direct current shock. Coronary angiography with isosorbide dinitrate showed neither spasm nor embolism in the coronary artery. The chest pain disappeared after 6 min with resolution of the ST‐segment elevation. A summarized review of ST‐segment elevation associated with transseptal puncture disclosed that ST‐segment elevation is often found in inferior leads (87.5%), while concomitant bradyarrhythmia has been reported in 43.8% of patients. Our patient is the first recorded case with potentially lethal tachyarrhythmia. Although ST‐segment elevation and VF is a rare complication associated with transseptal puncture, awareness of this complication is important.
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Ishigaki et al. (2013) studied this question.
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