Key result
Left lateral accessory pathway ablation linked to rare late LAD occlusion and arteriovenous fistula.
Why the study?
Rare and severe complications such as acquired arteriovenous fistula and chronic LAD occlusion after endocardial catheter ablation of left-sided accessory pathways have been infrequently reported.
Case Report (n=1)
Endocardial catheter ablation of left-sided accessory pathways may rarely lead to severe late complications such as LAD occlusion and AV fistula formation.
May reduce transaortic complications in left-sided pathway ablation; leaves open need for prospective validation before practice change.
Endocardial catheter ablation of accessory pathways is now considered as therapy of first choice in symptomatic patients. Success rates depend on the location of the accessory pathway itself and the operators experience in catheter ablation procedures. In patients with a left-sided pathway the retrograde transaortic catheter approach is used routinely in most centers. Besides occasional injuries of the vessels used for catheter placement and perforation of the cardiac chambers, there have been only a few case reports in the literature reporting rare procedure-specific complications such as catheter entrapment within the mitral valve apparatus and occlusion of the left circumflex coronary artery. We report a case of primary successful endocardial catheter ablation of a left lateral accessory pathway in a patient with normal coronary arteries at that time. Many years later progressive deterioration of systolic left ventricular function was observed. Coronary angiography revealed occlusion of LAD next to a arteriovenous (AV) fistula between the LAD and the anterior right ventricle. Endocardial catheter ablation was the only known cardiac manipulation in this patient raising the possibility that unintended catheter manipulations within the LAD had led to this rare and severe complication.
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Wieczorek et al. (2005) conducted a case report in Left-sided accessory pathway (n=1). Endocardial catheter ablation was evaluated. Endocardial catheter ablation of a left lateral accessory pathway was identified as the likely cause of a rare late complication involving LAD occlusion and an arteriovenous fistula in 1 patient.
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