Anterior Mitral Line Ablation-Induced Complete Heart Block: A Cautionary Case Study.

IF 1 Q3 MEDICINE, GENERAL & INTERNAL American Journal of Case Reports Pub Date : 2024-11-07 DOI:10.12659/AJCR.945818
Gabriel Velez Oquendo, Nivedha Balaji, Joon Ahn
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Abstract

BACKGROUND Atrial flutter is associated with significant morbidity and mortality. Standard treatment involves rate and rhythm control medications, with ablation procedures reserved for more persistent cases. While ablation is generally successful, it carries risks, such as complete heart block, as in this case. CASE REPORT A 73-year-old woman presented for ablation of recurrent atypical atrial flutter. Electro-anatomic mapping demonstrated counterclockwise mitral annular flutter. An anterior ablation line was initially created from the right superior pulmonary vein to the mitral valve annulus. As the line was extended to the anterior mitral valve annulus at the 9 o'clock position, complete heart block occurred, and ablation was immediately terminated. Complete recovery of atrioventricular (AV) conduction occurred within 1 min. The catheter tip was within 1.8 cm from the His bundle, as denoted by the yellow tag on the CARTO map. A second mitral line was created anteriorly at the 11 o'clock position on the mitral valve annulus and extended to the left atrial roof line, with the termination and creation of a bi-directional mitral isthmus block. She remained in sinus rhythm after ablation, with PR prolongation and no AV block. The following day, she developed severe bradycardia due to complete heart block, with a slow ventricular escape rhythm, requiring implantation of a permanent pacemaker. CONCLUSIONS This case underscores the importance of precise catheter positioning during anterior mitral line ablation to prevent complications, such as AV block. Anterior mitral line ablation should be performed in a more anterior location away from the septum to minimize the risk of AV block.

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二尖瓣前线消融诱发完全性心脏传导阻滞:警示性病例研究。
背景 心房扑动与严重的发病率和死亡率有关。标准的治疗方法包括服用控制心率和心律的药物,而消融术则适用于较为顽固的病例。虽然消融术一般都能取得成功,但也存在风险,例如本病例中的完全性心脏传导阻滞。病例报告 一位 73 岁的女性因反复发作的非典型心房扑动前来接受消融治疗。电解剖图显示她患有逆时针二尖瓣环扑。最初从右上肺静脉到二尖瓣环创建了一条前消融线。当消融线延伸至二尖瓣环前9点钟位置时,发生了完全性心脏传导阻滞,消融随即终止。房室(AV)传导在 1 分钟内完全恢复。导管尖端距离 His 束不到 1.8 厘米,如 CARTO 地图上的黄色标记所示。在二尖瓣环 11 点钟位置的前方创建了第二条二尖瓣线,并延伸至左心房顶线,终止并创建了双向二尖瓣峡阻滞。消融术后,她仍保持窦性心律,PR 延长,无房室传导阻滞。第二天,她因完全性心脏传导阻滞出现严重心动过缓,伴有缓慢的心室逸搏,需要植入永久起搏器。结论 本病例强调了二尖瓣前线消融术中导管精确定位对预防房室传导阻滞等并发症的重要性。二尖瓣前线消融术应在远离室间隔的更靠前的位置进行,以将房室传导阻滞的风险降至最低。
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来源期刊
American Journal of Case Reports
American Journal of Case Reports Medicine-Medicine (all)
CiteScore
1.80
自引率
0.00%
发文量
599
期刊介绍: American Journal of Case Reports is an international, peer-reviewed scientific journal that publishes single and series case reports in all medical fields. American Journal of Case Reports is issued on a continuous basis as a primary electronic journal. Print copies of a single article or a set of articles can be ordered on demand.
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