Sakai Togo, Takemoto Masao, Kitamura Taisuke, Tsuchihashi Takuya
Cardiovascular Centre, Social Medical Corporation Steel Memorial Yawata Hospital, 1-1-1 Haruno-machi, Yahatahigashi-ku, Kitakyushu 805-8508, Japan.
Cerebrovascular Centre, Social Medical Corporation Steel Memorial Yawata Hospital, 1-1-1 Haruno-machi, Yahatahigashi-ku, Kitakyushu, Japan.
Eur Heart J Case Rep. 2025 Aug 22;9(9):ytaf413. doi: 10.1093/ehjcr/ytaf413. eCollection 2025 Sep.
ST-segment elevations in electrocardiogram associated with coronary air embolisms (CAEs) and/or myocardial ischaemia induced by coronary artery spasms (CASs) are rare complications during ablation of atrial fibrillation (AF); some patients develop severe conditions. Contrast-induced encephalopathy (CIE) is also a rare but severe complication associated with the use of iodinated contrast agents during various cardiovascular and neurovascular procedures. Its occurrence during ablation, particularly AF ablation, remains unreported.
We report a case in which CASs and/or CAEs associated with ST-segment elevation were observed, accompanied by worsening haemodynamics during AF cryoablation. Insertion of an intra-aortic balloon pump improved the haemodynamics. Following anaesthesia recovery, he developed verbal/expressive aphagia and left-sided hemiplegia. However, emergent cerebrovascular angiography revealed no cerebral artery occlusions or haemorrhage. Plain computed tomography (CT) showed diffuse cortical hyperdensity in the right temporal and both occipital lobes on Day 0, brain swelling by Day 2, and complete radiological recovery by Day 4. His symptoms, except for a slight grip drop of the left hand, improved by Day 4, leading to a diagnosis of CIE.
The key step of CIE may be attributed to a blood-brain barrier breakdown, which is influenced by multiple factors, including the direct chemotoxicity and hyperosmolarity of the contrast agent, ischaemic stroke (including cerebral vasoconstriction), and anaesthesia. Thus, physicians should consider the possibility of CIE when a patient exhibits neurological abnormalities during ablation, despite a lack of a CIE history with contrast-enhanced CT.
在心房颤动（AF）消融过程中，心电图上与冠状动脉空气栓塞（CAE）和/或冠状动脉痉挛（CAS）诱发的心肌缺血相关的ST段抬高是罕见的并发症；一些患者会发展为严重情况。对比剂诱导的脑病（CIE）也是在各种心血管和神经血管手术中使用碘化对比剂相关的一种罕见但严重的并发症。其在消融过程中，尤其是AF消融过程中的发生情况尚未见报道。
我们报告1例在AF冷冻消融过程中观察到与ST段抬高相关的CAS和/或CAE，并伴有血流动力学恶化的病例。主动脉内球囊泵置入改善了血流动力学。麻醉恢复后，患者出现言语/表达性失语和左侧偏瘫。然而，紧急脑血管造影显示无脑动脉闭塞或出血。平扫计算机断层扫描（CT）显示第0天右侧颞叶和双侧枕叶弥漫性皮质高密度，第2天脑肿胀，第4天影像学完全恢复。到第4天，除左手轻度握力下降外，他的症状有所改善，从而诊断为CIE。
CIE的关键步骤可能归因于血脑屏障破坏，这受多种因素影响，包括对比剂的直接化学毒性和高渗性、缺血性卒中（包括脑血管收缩）以及麻醉。因此，尽管患者无对比增强CT检查的CIE病史，但在消融过程中出现神经异常时，医生应考虑CIE的可能性。
