Intramyocardial Hematoma During Catheter Ablation for Scar-Related Ventricular Tachycardia.
JACC Clin Electrophysiol
; 9(11): 2303-2314, 2023 11.
Article
en En
| MEDLINE
| ID: mdl-37632506
ABSTRACT
BACKGROUND:
Intramural hematoma during ablation for scar-related ventricular tachycardia (VT) is a rare but life-threatening complication.OBJECTIVES:
The goal of this study was to describe the features and outcomes of intramural hematoma during ablation for scar-related VT.METHODS:
From 2010 to 2022, >3,514 ablations for ventricular arrhythmias were performed at 2 institutions. Four cases of intramural hematoma complicating VT ablation for scar-related VT were identified. Intraprocedural details, imaging data, and surgical notes were reviewed to create a recognizable pattern of events highlighting this complication.RESULTS:
In 3 of 4 cases, intramural hematoma occurred during catheter ablation with an open irrigated 3.5 mm tipped catheter using normal saline for irrigation. In one case, hematoma was noted after ablation using an investigational needle electrode catheter. The occurrence of a steam pop preceded detection of an expanding intramural hematoma in 3 cases. ST-segment elevation on electrocardiography was evident in 3 cases; intracardiac echocardiographic imaging detected the hematoma in all cases. Epicardial rupture and pericardial effusion requiring drainage occurred in 3 cases, whereas 1 hematoma was self-contained and did not require intervention. Surgical intervention was performed in 2 cases, with successful outcomes. One patient who was deemed not a surgical candidate died of progressive cardiogenic shock.CONCLUSIONS:
Intramural hematoma during ablation for scar-related VT is a rare but potentially catastrophic complication that requires prompt recognition. Steam pops during ablation frequently precede the hematoma formation. Surgical intervention may be life-saving, although contained hematomas can occasionally be managed conservatively.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Taquicardia Ventricular
/
Ablación por Catéter
Límite:
Humans
Idioma:
En
Revista:
JACC Clin Electrophysiol
Año:
2023
Tipo del documento:
Article