Kang Honsa, Takemoto Masao, Watanabe Takanori, Hironaga Kiyoshi
Cardiovascular Centre, Fukuoka City Hospital, 13-1 Yoshizukahon-machi, Hakata-ku, Fukuoka 812-0046, Japan.
Cardiovascular Centre, Social Medical Corporation Steel Memorial Yawata Hospital, 1-1-1 Haruno-machi, Yahata-higashi-ku, Kitakyushu 805-8508, Japan.
Eur Heart J Case Rep. 2024 Dec 30;9(1):ytae701. doi: 10.1093/ehjcr/ytae701. eCollection 2025 Jan.
Radiofrequency ablation (RFA) procedures including cavo-tricuspid isthmus (CTI) ablation have proven to be safe and effective therapies for the treatment of many cardiac tachyarrhythmias. The incidence of coronary arterial injury (CAI) associated with RFA including CTI ablation is estimated to occur in <0.1% of patients. Most instances of CAI occur during ablation procedures or within a few weeks after RFA.
We report a case of delayed manifestation of CAI of the right coronary artery 1 year after RFA, likely associated with a CTI ablation. The coronary angiography and intravascular ultrasound images revealed significant stenotic lesions primarily consisted of heterogeneous fibrous plaques including few echolucent lesions that consisted of a relatively smaller lipid or necrotic core without echo-attenuated plaques consisting of a fibroatheroma with a necrotic core or pathological intimal thickening with a lipid pool, and corresponded to the site of the CTI ablation. The patient remained stable without any symptoms 6 months post-percutaneous coronary intervention at that site.
Physicians should consider the possibility of CAI associated with RFA procedures involving ablation near the coronary arteries (CAs) in patients presenting with chest discomfort after RFA, even when the presentation is remote from the index procedure. Unanticipated anatomic variations can predispose to CAIs. Therefore, awareness of the relationship between CA course and anatomical ablation site before RFA may be important to prevent CAIs and improve procedural safety.
包括三尖瓣峡部（CTI）消融在内的射频消融（RFA）手术已被证明是治疗多种心脏快速性心律失常的安全有效疗法。与包括CTI消融在内的RFA相关的冠状动脉损伤（CAI）发生率估计在<0.1%的患者中发生。大多数CAI病例发生在消融手术期间或RFA后的几周内。
我们报告了1例RFA术后1年出现右冠状动脉CAI延迟表现的病例，可能与CTI消融有关。冠状动脉造影和血管内超声图像显示，显著的狭窄病变主要由异质性纤维斑块组成，包括少数无回声病变，这些病变由相对较小的脂质或坏死核心组成，无由伴有坏死核心的纤维粥样瘤或伴有脂质池的病理性内膜增厚组成的回声衰减斑块，且与CTI消融部位相对应。在该部位进行经皮冠状动脉介入治疗6个月后，患者病情稳定，无任何症状。
对于RFA术后出现胸痛的患者，即使症状出现在远离初次手术的时间，医生也应考虑与靠近冠状动脉（CA）进行消融的RFA手术相关的CAI可能性。意外的解剖变异可能易导致CAI。因此，在RFA前了解CA走行与解剖消融部位之间的关系对于预防CAI和提高手术安全性可能很重要。
