BACKGROUND: Acute post-ablation pericarditis is the most common complication of epicardial ablation of ventricular arrhythmias, while regional pericarditis following an initially uneventful endocardial catheter ablation (CA) procedure is a rare and elusive diagnosis. CASE SUMMARY: We report a case of a 66-year-old Russian female who developed chest pain accompanied by electrocardiogram (ECG) changes-biphasic T waves in V1-V4 leads after an initially uncomplicated premature ventricular complex CA procedure. After examination and investigations, including transthoracic echocardiography (TTE), cardiac magnetic resonance imaging (CMR) and cardiac computed tomography (CCT), she was diagnosed with regional pericarditis, which occurred even though the ablation was uneventful with the limited number of radiofrequency applications. Furthermore, the diagnosis was difficult due to normal body temperature and the absence of pericardial effusion and myocardial abnormalities on TTE, findings that are not characteristic of pericarditis. The patient's last office visit was in 6 months after the procedure. Neither patient had any complaintsnor there were any changes on ECG and TTE. DISCUSSION: Regional post-ablation pericarditis is a relatively rare type of post-cardiac injury syndrome (PCIS). The varying severity of the PCIS clinical course makes the diagnosis of post-ablation pericarditis initially difficult, especially in patients undergoing an uneventful CA procedure. Non-invasive imaging modalities as CMR and CCT should be considered initially in elusive cases of PCIS.
BACKGROUND: Early recurrences of atrial arrhythmias (ERAA) after atrial fibrillation (AF) catheter ablation do not predict procedural failure. A well-demarcated homogeneous lesion delivered by cryoballoon is less arrhythmogenic, and the recommended three-months blanking period may not refer to cryoballoon ablation (CBA). OBJECTIVE: We aimed to evaluate the predictive role of ERAA after second-generation CBA using an implantable loop recorder. METHODS: This prospective observational study enrolled 100 patients (58 males, median age 58) with paroxysmal/persistent AF undergoing pulmonary vein (PV) CBA using second-generation cryoballoon with simultaneous ECG loop recorder implantation. The duration of follow-up was 12 months, with scheduled visits at 3, 6 and 12 months. RESULTS: 99 patients from 100 completed the 12-month follow-up period. ERAA occurred in 31.3 % of patients. 83.9 % of patients with ERAA also developed late recurrences. The 12-month freedom from AF in patients with ERAA was significantly lower than in those without ERAA (p < 0.0001). Non-paroxysmal AF and longer arrhythmia history were associated with increased risk of both early (HR 3.27; 95 % CI 1.32-8.08; p = 0.010 and HR 1.0147; 95 % CI 1.008-1.086; p = 0.015, respectively) and late recurrences (HR 3.89; 95 % CI 1.67-9.04; p = 0.002 and HR 1.0142; 95 % CI 1.007-1.078; p = 0.019, respectively) of AF. ERAA were another predictor for procedural failure (HR 15.2; 95 % CI (6.42-35.99; p = 0.019). CONCLUSIONS: ERAA occurred in the third of the patients after PV second-generation CBA and are strongly associated with procedural failure. Longer duration of AF history and persistent AF are independent predictors of AF's early and late recurrence.
Atrial Fibrillation/surgery , Cryosurgery/adverse effects , Electrocardiography, Ambulatory , Pulmonary Veins/surgery , Remote Sensing Technology , Action Potentials , Atrial Fibrillation/diagnosis , Atrial Fibrillation/physiopathology , Electrocardiography, Ambulatory/instrumentation , Female , Heart Rate , Humans , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Pulmonary Veins/physiopathology , Recurrence , Remote Sensing Technology/instrumentation , Reproducibility of Results , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome
BACKGROUND: Catheter ablation (CA) of epicardial accessory pathways (APs) can be performed via the coronary sinus (CS) system. Variable CS anatomy with complications of former CA procedures inside the CS venous system may require using alternative CA approach and technology. CASE SUMMARY: We report the case of a 23-year-old man with Wolff-Parkinson-White syndrome and history of aborted sudden cardiac death (SCD) and unsuccessful previous AP radiofrequency ablation (RFA). CS venography during the redo procedure revealed an early CS trifurcation with cardiac veins stenosis, thus with difficulties in maintaining cardiac veins' access and catheter manoeuvring inside CS venous system. The last office visit with electrocardiogram (ECG) performance was in 3 months after the CA. Neither delta wave on the ECG nor any complaints/adverse health effects was detected at that time. DISCUSSION: Successful CA of epicardial AP in patients with a high risk of SCD is essential. However, CS complex anatomy and changes after former RFA inside it may lead to CS venous system access limitations. Alternative CA approach and technology should be considered to ensure CS venous system cannulation and epicardial AP CA performance.
