Antidepressants Relieved Consecutive Chest Pain after Radiofrequency Ablation

Abstract

Preexcitation symptom presents morbidity of 0.1% to 0.3% in the general population, which could lead to deadly events while accompanying arrhythmia. The classical type is Wolff-Parkinson-White (WPW) syndrome characterized as a shorter PR period, longer QRS duration, and δ wave. Radiofrequency catheter ablation (RCA) takes a vital role in treating WPW and has a high success rate. While some patients complain of consecutive chest pain after RCA, which influence their daily life severely. A 45-year-old man went to a hospital for examination because of uncomfortable palpitation. The electrocardiogram (ECG) presenting WPW syndrome (left free wall accessory pathway), then he was admitted to the hospital and scheduled for RCA. The RCA was very successful and the ECG became normal. However, after ablation, he reported consecutive chest pain, accompanied by insomnia and hypertension. No abnormal elevations of cardiac-Troponin I, myoglobin, cytokeratin, creatine kinase MB were found, and the left ventricular ejection fraction was 60%. His mental status was measured by Patient-Health Questionnaire-9, 7-item Generalized Anxiety Disorder Scale-7, Athens Insomnia Scale, indicating depressive status and anxiety status. The predominant managements involved flupentixol-melitracen and duloxetine. His chest pain, depressive, and anxiety symptoms were gradually relieved after 3-month treatment, and the drugs were slowly tapered in the 1½ years' follow-up period. Ultimately, he recovered and worked as before. This case highlights the importance of evaluating psychological status in patients with unexplained chest pain resulting from RCA and adopting antidepressants in those patients that coexist with definite depression or anxiety.