Danger to the ventricular myocardium from prolonged ablation procedures combined with a long-lasting catecholamine infusion for provocative arrhythmia testing

Abstract

In this issue of Europace , Hasdemir et al. report on a case of what they term ‘stress cardiomyopathy ( tako-tsubo )’ following radiofrequency ablation in the right ventricular outflow tract.1 The most relevant lesson from this case report is that very prolonged ablation procedures may result in a transient left ventricular (LV) systolic dysfunction or stress cardiomyopathy, particularly when catecholamines are infused over a long period to test the result of intervention. In this case, radiofrequency was delivered for up to 21 min, which meant that the procedure was very long-lasting and most likely stressful for a non-sedated patient. This, together with the also very prolonged duration of the dopamine infusion (maintained during the whole ablation procedure plus for 90 min after the last radiofrequency application) implies a strong and protracted intrinsic and extrinsic adrenergic stimulus, the known common denominator for developing a stress cardiomyopathy.2 A second issue raised … *Corresponding author. Tel: +34 91 544 1636; fax: +34 91 549 9402. E-mail address: jfarre{at}fjd.es