Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
J Cardiovasc Electrophysiol. 2013 Aug;24(8):929-32. doi: 10.1111/jce.12083. Epub 2013 Jan 30.
We report a case of aborted sudden cardiac death and subsequent development of malignant drug-refractory incessant ventricular tachycardia/fibrillation in a patient with acute coronary artery occlusion following radiofrequency ablation within the CS. Catheter ablation is a well-established therapy for treatment of atrial fibrillation (AF). In patients with longstanding persistent AF extensive left atrial ablation and ablation inside the coronary sinus (CS) is frequently performed. Perimitral flutter following AF ablation is the most common form of left atrial macroreentry, especially in patients with previous ablation of complex fractionated electrograms and incomplete linear lesion sets within the left atrium. Successful ablation of this type of tachycardia is generally difficult and in about 60-70% patients requires additional ablation within the CS to achieve termination of tachycardia or/and left atrial isthmus (LAI) block. A limited number of case reports have been published describing acute coronary artery occlusion during or immediately after LAI ablation within the CS. This case exhibits a potential lethal risk of radiofrequency ablation within the CS.
我们报告了一例心搏骤停后猝死的病例，随后发展为恶性药物难治性无休止性室性心动过速/颤动，该患者在 CS 内射频消融后发生急性冠状动脉闭塞。导管消融是治疗心房颤动（AF）的一种成熟疗法。对于持续性长程 AF 患者，通常需要进行广泛的左心房消融和冠状窦（CS）内消融。AF 消融后出现二尖瓣环型房扑是最常见的左心房大折返形式，尤其是在既往消融复杂碎裂电图和左心房不完全线性病变的患者中。这种类型的心动过速的成功消融通常较为困难，约 60-70%的患者需要在 CS 内进行额外消融以终止心动过速或/和左心房峡部（LAI）阻滞。已有少数病例报告描述了 CS 内 LAI 消融过程中或之后发生急性冠状动脉闭塞。本病例显示了 CS 内射频消融的潜在致命风险。
