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Europace Advance Access originally published online on February 28, 2008
Europace 2008 10(5):609; doi:10.1093/europace/eun037
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

ABLATION FOR ATRIAL FIBRILLATION

Unusual thrombo-embolic event after radiofrequency ablation

Marek Kiliszek*, Edward Kozluk and Piotr Scislo

1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland

Manuscript submitted 3 December 2007. Accepted after revision 21 January 2008.

* Corresponding author. Tel: +48 22 599 2958; fax: +48 22 599 1957. E-mail address: kiliszek{at}mp.pl or 74mk{at}wp.pl

Key Words: RF ablation, Thrombo-embolic event, Atrioventricular nodal re-entry tachycardia

We present an otherwise healthy 21-year old man, after successful radiofrequency ablation of the slow pathway due to atrioventricular nodal re-entry tachycardia. The procedure lasted 145 min, and there were seven applications of RF current (253 s). During ablation, the patient received heparin 1000 IU iv.

In control echocardiography (6 h later), there was a pathological moving structure within the right ventricle. There were no other pathologies in echocardiography (normal function of left ventricle, normal function of the heart valves, and no pericardial effusion). On the next day, we performed a transoesophageal echocardiography (Figure 1). Within the right ventricle, there was a polycystic moving structure 3.7 cm long and 0.7 cm in diameter, seemingly attached to the interventricular septum of the right ventricle. After ablation, the patient was treated routinely with enoxaparin 40 mg sc bid (two doses) and aspirin 75 mg per day. Laboratory tests and D-dimers were normal (239.4 ng/mL; n < 500). The patient had no clinical symptoms. On the 4th day after ablation, in a control echocardiography, we were not able to find myxoma-like structure any more. On spiral computerized tomography, we found one small thrombus within a segmental pulmonary artery.


Figure 1
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  		Figure 1 (A and B) Transoesophageal echocardiography: polycystic, moving structure within the right ventricle.

 
The nature of the structure of Figure 1 is unclear. Most probably, this was a thrombus (despite negative D-dimers) that developed during the procedure in the femoral or iliac vein, dislocated to the right heart, and disappeared after a few days with subclinical pulmonary embolism.


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This Article
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