Key result
Pulmonary vein isolation for focal atrial fibrillation can cause acute chest pain, ECG signs mimicking acute inferior wall myocardial infarction, and elevated cardiac Troponin I.
Case Report
During pulmonary vein isolation for atrial fibrillation, manipulation of the left atrium can cause transient chest pain, ECG changes mimicking inferior MI, and troponin elevation.
Clinicians should recognize PVI-induced MI mimicry; single case leaves open incidence and need for prospective data.
In this study, we report an intraprocedural incident in patients undergoing ablation for atrial fibrillation. During left atrial manipulation our patients suffered from acute chest pain, showed ECG signs of an acute inferior wall myocardial infarction, and increased levels of cardiac Troponin I (cTnI). We strongly recommend being aware of unexpected reactions during isolating pulmonary veins for focal atrial fibrillation, especially when passing the dorsal part of the left atrium. If pericardial effusion is ruled out and ECG signs as well as symptoms disappear, the ablation procedure should proceed. We think patients undergoing pulmonary vein ablation for atrial fibrillation should be informed of this threatening complication.
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Schwab et al. (2004) conducted a case report in Focal atrial fibrillation. Pulmonary vein isolation was evaluated on Intraprocedural incident (acute chest pain, ECG signs of acute inferior wall MI, increased cTnI). Pulmonary vein isolation for focal atrial fibrillation can cause acute chest pain, ECG signs mimicking acute inferior wall myocardial infarction, and elevated cardiac Troponin I.
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