Accelerated idioventricular rhythm after left atrial tachycardia ablation as a marker of acute coronary ischemia John Whitaker, MB, BCh, MRCP, Hariharan.

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Presentation transcript:

Accelerated idioventricular rhythm after left atrial tachycardia ablation as a marker of acute coronary ischemia John Whitaker, MB, BCh, MRCP, Hariharan Raju, MB, ChB, MRCP, PhD, Carly Taylor, BSc (Hons), CCDS (IBHRE/AP), C. Aldo Rinaldi, FRCP, FHRS HeartRhythm Case Reports Volume 1, Issue 3, Pages 99-102 (May 2015) DOI: 10.1016/j.hrcr.2014.12.004 Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 1 A: Electrocardiogram demonstrating atrial tachycardia causing symptoms before the ablation procedure. B: CARTO 3 anatomy (electro-anatomic mapping system used to generate visual representation of left atrial anatomy) in the left lateral view and location of radiofrequency lesions. Arrows indicate endocardial mitral isthmus ablation (1) and epicardial radiofrequency ablation within the coronary sinus (2). The mitral annulus (MA) is also indicated. Epicardial placement of lesions is likely to have increased the risk of direct circumflex artery injury such as that experienced by our patient. HeartRhythm Case Reports 2015 1, 99-102DOI: (10.1016/j.hrcr.2014.12.004) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 2 A: Accelerated idioventricular rhythm after radiofrequency ablation procedure: the first indication of significant coronary ischemia. The morphology of the QRS complex suggests an inferoposterior focus for the rhythm because of the superior axis (arrows 1) and the precordial positive concordance (arrows 2), which would localize it to the site of the identified circumflex stenosis and the site of epicardial radiofrequency ablation in the coronary sinus. B: Electrocardiogram in sinus rhythm after the administration of atropine and morphine (12 minutes after electrocardiogram shown in panel A). C: Coronary angiography in left anterior oblique 30°/caudal view, demonstrating severe distal circumflex stenosis at the site correlating with the application of epicardial RF application. HeartRhythm Case Reports 2015 1, 99-102DOI: (10.1016/j.hrcr.2014.12.004) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 3 A: Electrocardiogram (ECG) 40 minutes after ECG shown in panel B, demonstrating mild ST-segment depression in leads V4-V6 (arrows). B: Resolution of ECG changes after percutaneous coronary intervention to left circumflex artery. C: Coronary angiography in left anterior oblique 30°/caudal view after treatment of circumflex stenosis, demonstrating an unobstructed circumflex artery after successful percutaneous coronary intervention. HeartRhythm Case Reports 2015 1, 99-102DOI: (10.1016/j.hrcr.2014.12.004) Copyright © 2015 Heart Rhythm Society Terms and Conditions