https://orcid.org/0000-0003-4363-0259
A 67-year-old man with ischaemic cardiomyopathy was admitted to our hospital. Pulmonary vein isolation for persistent atrial fibrillation and radiofrequency (RF) catheter ablation for peri-mitral atrial tachycardia from the endocardial and epicardial via the great cardiac vein (GCV) were performed. A total of seven RF applications were applied (15–20 W, 10 s each) from inside the GCV using an irrigated-tip catheter (triangles in panel A). Even after undergoing coronary artery bypass, percutaneous transcatheter mitral valve repair for functional mitral regurgitation, and optimal medical therapy, left ventricular ejection fraction (LVEF) was not improved. Therefore, 1 year after ablation, he received cardiac resynchronization therapy with defibrillator (CRT-D) for low LVEF (30%), intraventricular conduction disturbance, and non-sustained ventricular tachycardia. During implantation, venography revealed the occlusion of the GCV (triangles in panel B). A post hoc review of the post-surgery computer tomography (CT) showed the sudden interruption of the GCV (triangles in panel C), suggesting the occlusion of the GCV. The left ventricular lead was implanted at the postero-lateral vein (arrows in panel D), which branches from the proximal of GCV.
This case highlights a late complication of RF application within the coronary venous system that can lead to venous occlusion. Creating a mitral isthmus line is challenging and sometimes requires RF application within the coronary vein. CRT requires lead placement in postero-lateral or lateral coronary vein suitable for left ventricular pacing. Therefore, it is important to be aware of this infrequently reported complication in patients who may indicate CRT-D.
Data availability
No new data were generated or analysed in support of this report.
Author notes
Conflict of interest: Dr. Shingo Sasaki has received research grant supports from Medtronic Japan Co., Ltd. and Fukuda Denshi Kita-Tohoku Hanbai Co., Ltd. and BIOTRONIK Japan Co., Ltd. Dr. Shingo Sasaki has received scholarship donation from Japan Lifeline Co., Ltd and Boston Scientific Japan Co., Ltd. Dr. Masaomi Kimura is an associate professor of the department of Advanced Management of Cardiac Arrhythmias, which is an endowment department supported by Medtronic Japan Co., Ltd., Japan Lifeline Co., Ltd, and Fukuda Denshi Kita-Tohoku Hanbai Co., Ltd. Dr. Hirofumi Tomita has received research grant supports from Medtronic Japan Co., Ltd., and Fukuda Denshi Kita-Tohoku Hanbai Co., Ltd., and BIOTRONIK Japan Co., Ltd, and scholarship grants from Japan Lifeline Co. Other authors have no relevant disclosures.
