Cryoablation of atrial fibrillation complicated by acute bacterial endocarditis

Abstract

Keywords Catheterablation .Atrialfibrillation .Cryoablation .Endocarditis1 IntroductionA 62-year-old man was referred for ablation of atrial fibrilla-tion (AF). On a pre-procedural echocardiogram, left atriumand mitral valve were normal. Pulmonary vein isolation wasperformed, using one hexapolar catheter, 23 and 28 mm cry-oballoons, one intracardiac echocardiography catheter, onemicrocircular octopolar and one standard decapolar lassomapping catheters. Total procedure duration was 200 min;cumulative duration of cryoapplication was 52.5 min. Nolinear radiofrequency lesion was performed. He was dis-charged from the hospital 48 h later. On post-procedure day5, he experienced mental confusion, chills and fever. Uponreadmission, he was in severe sepsis with a left central facialpalsy and bilateral absence of radial pulses. Imaging studiesrevealedembolecinfarcts,innoatrio-oesophagealfistulaand,on transoesophageal echocardiogram, a 12-mm vegetationattached to the posterior mitral leaflet (Fig. 1). Methicillin-sensitive Staphylococcus aureus was grown. He was placedonaregimen ofdoubleantimicrobial therapyfor6weeksandunderwent bilateral surgical revascularization of the upperextremities, with findingsof mycotic aneurysms.After 1 yearof follow-up, he was in stable health and free from AF,without neurological sequelae or mitral valve regurgitation.S. aureus may lead to a fulminating infectious process [1]and infective endocarditis has been reported after radiofre-quency ablation. The unusually lengthy cryoapplication andthe exchanges of multiple catheters may have a role.