What question did this study set out to answer?

The aim is to report a rare complication of hepatic hemorrhage following catheter ablation for atrial tachycardia.

March 28, 2026Open Access

Hepatic vein injury after atrial tachycardia ablation: a rare cause of hemoperitoneum – Case Report

Key Result

Hepatic vein injury from guidewire passage during atrial tachycardia ablation is a rare but life-threatening complication that can cause severe hemoperitoneum requiring emergency laparoscopy.

Key Points

The aim is to report a rare complication of hepatic hemorrhage following catheter ablation for atrial tachycardia.
Case study of a 67-year-old man with a history of atrial arrhythmias and previous ablations.
Post-ablation evaluation included imaging to diagnose hemoperitoneum.
Emergency laparoscopic intervention was performed to identify and manage hepatic bleeding.
Patient developed severe right flank pain and hypotension after the ablation.
Imaging revealed extensive hemoperitoneum near the right hepatic vein.
Capsular venous bleeding was identified and cauterized during emergency surgery.

Structured PICO

Population

67-year-old man with a history of mitral valve repair and multiple ablation procedures for atrial fibrillation, atrial flutter and macro-reentrant atrial tachycardia (MRAT)

Intervention

Redo catheter ablation for MRAT

Outcome

Hepatic hemorrhage/hemoperitoneumsafety

Hepatic vein injury causing life-threatening hemoperitoneum is a rare but serious complication of catheter ablation that requires prompt multidisciplinary intervention.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Background Catheter ablation for atrial arrhythmias is a common procedure with possibility of causing complications, typically involving vascular access sites or cardiac tamponade. However, hepatic hemorrhage as a complication of cardiac catheter ablation is extremely rare. We present a case of life-threatening intra-abdominal bleeding originating from a hepatic vein following a catheter ablation for atrial tachycardia. Case Summary A 67-year-old man with a history of mitral valve repair and multiple ablation procedures for atrial fibrillation, atrial flutter and macro-reentrant atrial tachycardia (MRAT) underwent a redo catheter ablation for MRAT. After the procedure, he developed right flank pain, hypotension, and a drop in hemoglobin. Imaging revealed extensive hemoperitoneum, originating near the right hepatic vein. Angiography of the visceral arteries was performed on which no major source of bleeding was identified. Because of persisting hemodynamic instability, the patient underwent emergency laparoscopy during which a capsular venous bleeding on the caudal liver surface was identified, likely caused by transient guidewire passage and injury in the hepatic veins. The bleeding was cauterized and abdominal lavage was performed to clear the hemoperitoneum. He was transferred to ICU for vasopressor support. Anticoagulation was restarted one week later, and the patient was discharged in stable condition. Conclusion This case highlights a rare but serious complication of catheter ablation. Prompt recognition of intra-abdominal hemorrhage and a multidisciplinary approach involving cardiology, radiology, and surgery were crucial for a successful outcome. Operators should remain vigilant for atypical bleeding complications in ablation procedures and be prepared to initiate rapid intervention.