Dudzińska-Szczerba Katarzyna, Piotrowski Roman, Zaborska Beata, Pilichowska-Paszkiet Ewa, Sikora-Frąc Małgorzata, Żuk Anna, Lewandowski Paweł, Kułakowski Piotr, Baran Jakub
Department of Cardiology, Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland.
Am J Case Rep. 2019 Jul 7;20:971-974. doi: 10.12659/AJCR.916205.
BACKGROUND Catheter ablation for atrial fibrillation is an important therapeutic intervention. One of the most frequent complications of this procedure is vascular issues including arteriovenous fistula. Iatrogenic atrial septal defect (IASD) has been reported as a complication of transseptal puncture; however, no data are available demonstrating any coexistent of arteriovenous fistula with IASD. CASE REPORT A 61-year-old female patient was admitted to our center for catheter ablation for persistent atrial fibrillation. Her past medical history was significant for cryoballoon ablation for atrial fibrillation in 2015, which was subsequently complicated by hematoma and arteriovenous fistula at puncture site. After general surgery consultation, the patient was qualified for conservative treatment. To exclude left atrial thrombus before redo procedure, transesophageal echocardiography was performed which visualized the presence of 9-mm atrial septal defect with left-to-right shunting, detecting right-to-left shunting using Valsalva maneuver. No significant valvular abnormalities were identified. The next day, pulmonary vein isolation for atrial fibrillation was performed. One month later, a control transthoracic echocardiogram (TTE) revealed hemodynamic significant left-to-right shunting with Qp/Qs 2.0 and high probability of pulmonary hypertension. Vascular surgery for arteriovenous fistula was successfully performed in October 2018. Subsequent TTE, performed a month later, confirmed no left-to-right shunting and no signs of pulmonary hypertension or diminishment of the right atrium. CONCLUSIONS Vascular access during catheter ablation for atrial fibrillation may result in arteriovenous fistula. This condition might affect right atrium pressure leading to increased diameter of previous puncture site at the interatrial septum, causing IASD with significant shunting. In this group of patients, arteriovenous fistula should be treated as soon as possible.
导管消融治疗心房颤动是一项重要的治疗干预措施。该手术最常见的并发症之一是血管问题，包括动静脉瘘。医源性房间隔缺损（IASD）已被报道为经房间隔穿刺的并发症；然而，尚无数据表明动静脉瘘与IASD并存。病例报告：一名61岁女性患者因持续性心房颤动入住我院接受导管消融治疗。她既往有2015年因心房颤动接受冷冻球囊消融治疗的病史，随后穿刺部位出现血肿和动静脉瘘。经普通外科会诊，患者符合保守治疗条件。在再次手术前为排除左心房血栓，进行了经食管超声心动图检查，发现存在9毫米的房间隔缺损并伴有左向右分流，通过Valsalva动作检测到右向左分流。未发现明显的瓣膜异常。第二天，进行了心房颤动的肺静脉隔离术。一个月后，对照经胸超声心动图（TTE）显示血流动力学上有明显的左向右分流，Qp/Qs为2.0，且有肺动脉高压的高可能性。2018年10月成功进行了动静脉瘘的血管手术。一个月后进行的后续TTE证实无左向右分流，无肺动脉高压迹象，右心房也未缩小。结论：心房颤动导管消融过程中的血管通路可能导致动静脉瘘。这种情况可能会影响右心房压力，导致房间隔先前穿刺部位直径增加，从而引起伴有明显分流的IASD。在这组患者中，动静脉瘘应尽早治疗。
