P418 WHEN THE GAME IS HARD…. IT‘S BETTER TO COOPERATE! THE INTEGRATED MANAGEMENT OF THE ELECTROPHYSIOLOGIST AND HEMODYNAMIST WHO RESOLVES THE COMPLICATION

Abstract

Abstract A 66–year–old woman came to our attention to undergo ablation of monomorphic, frequent and repetitive premature ventricular complex, symptomatic and refractory antiarrhythmic therapy. Mapping of the arrhythmia showed precocity both on the anterolateral segment of the coronary sinus and on the anterolateral mitral annulus (corresponding to the point first identified in the coronary sinus). However, earliness on the anterolateral segment of the coronary sinus was better; radiofrequency was then applied there (maximum power of 30 Watts for 120 seconds). After a few minutes, blood pressure drop and echocardiogram showed tamponade pericardial effusion. Pericardiocentesis was performed and part of the drained blood recovered by connecting an 8F long introducer (inserted in the pericardium) to the introducer in the right femoral vein, thus stabilizing the patient‘s hemodynamics. The coronary sinus was selectively cannulated with an Agilis deflectable long introducer (advanced to the vessel ostium using a deflectable decapular electrocatheter as a guide) thus visualizing the lesion on the vessel wall site of ablation. A guiding catheter for the right coronary artery was inserted into the coronary sinus and a guidewire was advanced to the distal part of the vessel. The lesion was effectively treated by placing a 5 mm by 21 mm covered stent. After approximately one hour of monitoring, the pericardial drainage was removed. There were no recurrences of arrhythmia or pericardial effusion during observation in the ICU or at follow–up. In this complex case, the integrated management of the electrophysiologist and the hemodynamist successfully resolved the complication without resorting to cardiac surgery.