Left atrial \u0131ntramural hematoma after radiofrequency catheter ablation of left lateral accessory pathway

Salim Yaşar,Serkan Asil,Yalçın Gökoğlan,Hasan Kutsi Kabul,Suat Görmel

doi:10.1186/s42444-021-00041-z

Salim Yaşar, Serkan Asil + Show 3 more

Open Access

https://doi.org/10.1186/s42444-021-00041-z

Copy DOI

Abstract

We report a case of left atrial hematoma after ablation of left lateral concealed accessory pathway. A 46-year-old male patient experienced chest pain after radiofrequency ablation. Transthoracic echocardiography and computed tomography revealed the intramural mass consistent with hematoma in the left atrium. He was hemodynamically stable, and conservative approach was decided. Atrioventricular groove is a vulnerable part of left atrium, and ablation of left free wall accessory pathway may require targeting both atrial and ventricular surfaces of the mitral annulus. Avoidance of forceful catheter manipulation during the electrophysiological procedure is important for prevention of this complication. Optimal periprocedural anticoagulation might reduce the risk of procedure-related thromboembolic complications, but electrophysiologists should always pay attention to an intramural hematoma that may occur after radiofrequency catheter ablation.

Highlights

We report a case of left atrial hematoma after ablation of left lateral concealed accessory pathway
There was no AP conduction and tachycardia was not induced by programmed stimulation with or without isoproterenol infusion
RF catheter ablation of atrial tachyarrhythmias may lead to complications such as thromboembolism and bleeding [1]

Summary

Introduction

We report a case of left atrial hematoma after ablation of left lateral concealed accessory pathway. Transthoracic echocardiography and computed tomography revealed the intramural mass consistent with hematoma in the left atrium. He was hemodynamically stable, and conservative approach was decided. Electrocardiogram during one of these palpitation episodes showed narrow complex tachycardia with a rate of 190/min. He reported that his palpitation continued despite various antiarrhythmic (metoprolol and propafenon) treatments. Orthodromic atrioventricular reentrant tachycardia using left lateral concealed accessory pathway was induced. TTE revealed a well-circumscribed hypoechogenic mass in the lateral wall of the left atrium, suggestive of an intramural hematoma (Fig. 2).

Discussion

Conclusion