Right coronary artery wall edema provoked by cavotricuspid isthmus radiofrequency ablation Takuro Nishimura, MD, Masahiko Goya, MD, Shinya Shiohira,

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Presentation transcript:

Right coronary artery wall edema provoked by cavotricuspid isthmus radiofrequency ablation Takuro Nishimura, MD, Masahiko Goya, MD, Shinya Shiohira, MD, Takakatsu Yoshitake, MD, Yasuhiro Shirai, MD, Shingo Maeda, MD, Takeshi Sasaki, MD, Mihoko Kawabata, MD, Tetsuo Sasano, MD, Kenzo Hirao, MD HeartRhythm Case Reports Volume 3, Issue 9, Pages 443-446 (September 2017) DOI: 10.1016/j.hrcr.2017.07.010 Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 1 Eight seconds after the initial ablation was started at the cavotricuspid isthmus line, ST-segment elevation in inferior leads and 2:1 atrioventricular block (AVB) suddenly occurred following Wenckebach-type AVB. Abl = ablation catheter; CS = coronary sinus; TA = tricuspid annulus. HeartRhythm Case Reports 2017 3, 443-446DOI: (10.1016/j.hrcr.2017.07.010) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 2 A: The initial ablation point of the cavotricuspid isthmus ablation with a 3.5-mm-tip irrigated catheter. B: Coronary angiography showed that the atrioventricular nodal artery became 99% narrowed (white arrow). Cathe = catheter; CS = coronary sinus; LAO = left anterior oblique; RAO = right anterior oblique; TA = tricuspid annulus. HeartRhythm Case Reports 2017 3, 443-446DOI: (10.1016/j.hrcr.2017.07.010) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 3 Coronary angiography (CAG) shows the atrioventricular nodal artery occlusion immediately after the procedure and the improvement seen the next day. Real-time optical frequency-domain imaging (OFDI) showed that the vessel wall had swelled eccentrically with a low signal and had no attenuation at the narrowed site. After 5 months, CAG and OFDI showed that the vessel wall swelling had completely disappeared. HeartRhythm Case Reports 2017 3, 443-446DOI: (10.1016/j.hrcr.2017.07.010) Copyright © 2017 Heart Rhythm Society Terms and Conditions