Left ventricular pseudoaneurysm: As manifestation of a very rare complication of ablation of an accessory pathway

Abstract

Left ventricular pseudoaneurysm (LVPA) is a manifestation of cardiac rupture contained by pericardium or fibrous tissue. The natural course of LVPA after RFCA is not well-known because of the limited data in the literature. We describe the case of an LVPA manifesting rapidly after a WPW radiofrequency ablation. A 24-year-old woman presented to our department complaining of chest tightness and dyspnea, she had, six months earlier, undergone Successful RFCA without peri-procedural complications of a left posterolateral accessory pathway by retrograde transaortic approach. The procedure was performed using a 4-mm-tip non-irrigated conventional ablation catheter, there were no sudden impedance rises or popping sounds during the RFCA and the procedure was successfully finished. A relatively large amount of energy was delivered (521 seconds). The TTE showed an aneurysmal spherical pouch in the submitral area without pericardial effusion or valvular dysfunction. The cardiac MRI confirmed the presence of a LVPA of 22 × 36 mm without thrombus near to the mitral annulus ( Fig. 1 ) . RFCA is a well-established treatment of (SVT), with proven effectiveness and safety. LVPA is a form of cardiac rupture, its development can be early or late after the index procedure with various clinical manifestations. The patients with LVPA are prone cardiac rupture and sudden cardiac death, and the surgery is the unique treatment, even though one case of spontaneous regression of submitral pseudoaneurysm after RFCA was reported. Our attitude was to wait and repeat imaging exams for a period of two years known that the size of the LVPA remains stable; in addition to absence of a well codified management. In the last two decades, the complications of RFCA in WPW syndrome are well-known, and their management clearly codified, but not for this exceptional complication which the mechanism remains uncleared, as well as the best therapeutic proposal to be defined.