RESUMO
BACKGROUND: Acute myocardial infarction (AMI) is characterized by chest pain as well as cardiac troponin I (cTnI) and electrocardiography (ECG) changes. Recently, clinical researchers have used the term "MINOCA" to indicate myocardial infarction with nonobstructive coronary arteries. To the best of our knowledge, no report has documented MINOCA in a young patient after choledocholithiasis by endoscopic retrograde cholangiopancreatography (ERCP). CASE SUMMARY: An 18-year-old Chinese man presented to the cardiac intensive care unit with chest pain radiating to the left shoulder for 1 h after choledocholithiasis by ERCP and the following treatment. ECG showed a sinus rhythm with ST-segment elevation in the II, III, and aVF leads compared with the baseline. Laboratory data revealed cTnI levels of 67.55 ng/mL and 80 ng/mL at the peak (relative index below 0.034 ng/mL) and creatine kinase-MB levels of 56 U/L and 543 U/L at the peak (relative index below 24 U/L). AMI was suspected, and coronary angiography was performed the second day. The results revealed a smooth angiographic appearance of all arteries. The patient had been diagnosed with gallstones and cholecystitis for four years but had not accepted treatment. He had abdominal pain and bloating a week previously and underwent ERCP and subsequent treatments on the second day of admission; 1.4 cm × 1.6 cm of stones were removed from his common bile duct during surgery. The results of his laboratory tests at admission revealed abnormal alanine aminotransferase, aspartate aminotransferase, glutamyl transpeptidase, total bile acid, total bilirubin, direct bilirubin, and indirect bilirubin levels. His temperature, heart rate, blood pressure, and body mass index were normal. His echocardiographic examination revealed no obvious abnormalities in the structure and movement of the ventricular wall and an estimated left ventricular ejection fraction of 57% after the heart attack. His cholesterol and triglycerides were within normal ranges, and his low-density lipoprotein cholesterol was 2.23 mmol/L (normal range 2.03-3.34 mmol). Further testing after AMI revealed nothing remarkable in his erythrocyte sedimentation rate, thyroid function, and tumour markers. CONCLUSION: We ultimately made a diagnosis of MINOCA caused by coronary artery spasm, which seemed to be the most suitable diagnosis of this young patient. We are concerned that the heart attack may have been induced by the ERCP rather than occurred coincidentally afterward, so we should investigate the timing of the event further. Additional studies are needed to unravel the underlying pathophysiology.
RESUMO
BACKGROUND: The arrhythmogenicity of right atrial (RA) incisional scar after cardiac surgery could result in atrial tachycardia (AT). Radiofrequency catheter ablation is effective in the treatment of such tachycardia. However, data regarding long-term outcomes are limited. METHODS AND RESULTS: A total of 105 patients with prior RA incision who underwent radiofrequency catheter ablation of AT were included. In the first procedure, electroanatomic mapping (EAM) revealed a total of 139 ATs in 105 patients, including 88 cavotricuspid isthmus dependent atrial flutters (IDAFs), 5 mitral annulus reentrant tachycardias (MARTs), 44 intra-atrial reentrant tachycardias (IARTs) and 2 focal ATs (FATs). AT was successfully eliminated in 101 (96.1%) patients. During a mean follow-up period of 90 ± 36 months, recurrent AT was observed in 23 patients and 21 underwent a second ablation. A total of 23 ATs were identified in redo procedures including 4 IDAFs, 2 MARTs, 12 IARTs and 5 FATs. The time to recurrence was significantly different among various AT types. Acute success was achieved in 20 of 23 redo procedures. Taking a total of 21 patients presenting atrial fibrillation during follow-up into account, 85 patients (81.9%) were in sinus rhythm. No complications except for a case of RA compartmentation occurred. CONCLUSION: RA incisional scar played an essential role in promoting both IDAF and IART, while non-incisional scar contributed to a substantial rate of late recurrent AT in forms of both macroreentry and small reentry. Catheter ablation using EAM system resulted in a high success rate during long-term follow-up.