Sections of Cardiology, Rush University Medical Center, Chicago, Illinois 60612, USA.
J Cardiovasc Electrophysiol. 2010 Jul;21(7):818-21. doi: 10.1111/j.1540-8167.2009.01711.x. Epub 2010 Feb 1.
Right coronary artery (RCA) occlusion and acute myocardial infarction are rare during radiofrequency (RF) ablation of the cavotricuspid isthmus. Ventricular fibrillation (VF) or cardiac arrest in the periprocedural period may be the initial or only clinical manifestation. Septal or lateral RF delivery may increase the risk. We report 2 cases of RCA occlusion during ablation of typical atrial flutter (AFL). Angiographic and anatomical correlations are illustrated. One patient was ablated with a septal approach, the other with a lateral approach, and in each instance the RCA occluded near the ablative lesions. If septal or lateral ablation lines are contemplated during ablation of isthmus-dependent atrial flutter, fluoroscopic or electroanatomic confirmation of catheter position is pivotal. Smaller tipped catheters, energy titration (to minimally effective dose), saline irrigation, or cryoablation should also be considered to help avoid this serious complication.
右冠状动脉（RCA）闭塞和急性心肌梗死在射频（RF）消融房室结峡部时很少见。围手术期发生心室颤动（VF）或心脏骤停可能是最初或唯一的临床表现。间隔或侧部 RF 输送可能会增加风险。我们报告了 2 例典型房扑（AFL）消融过程中 RCA 闭塞的病例。图示了血管造影和解剖相关性。一名患者采用间隔部消融，另一名患者采用侧部消融，在这两种情况下，RCA 在消融病变附近闭塞。如果在消融依赖峡部的房扑时考虑进行间隔或侧部消融线，则透视或电解剖确认导管位置至关重要。还应考虑使用小尖端导管、能量滴定（至最小有效剂量）、盐水冲洗或冷冻消融，以帮助避免这种严重并发症。
