Radiofrequency ablation of a left posteroseptal accessory pathway via the coronary sinus can induce a Bezold-Jarisch-like phenomenon resulting in transient asystole.
We report a case of asystole induced by radiofrequency (RF) ablation via the coronary sinus in a 35-year-old man suffering from symptomatic left posteroseptal accessory pathway. RF application provoked progressive slowing of the sinus rhythm, disappearance of the preexcitation, and an 8-second period of asystole followed by atrial fibrillation. The causal mechanism proposed is a strong stimulation of vagal afferent pathways linked with sensory endings of the inferoposterior myocardial wall leading to a Bezold-Jarisch-like phenomenon.
Schläpfer et al. (Wed,) studied this question.