Document Detail

Transient ST-segment elevation during transseptal catheterization for atrial fibrillation ablation.
MedLine Citation:
PMID:  21224955     Owner:  NLM     Status:  MEDLINE    
For the treatment of refractory left atrial tachyarrhythmias, including atrial fibrillation, transseptal catheterization is often performed in order to achieve pulmonary vein isolation and left atrial substrate ablation. Herein, we report an unexpected ST-segment elevation in a 71-year-old man during a Brockenbrough transseptal catheterization procedure for atrial fibrillation ablation. The results of immediate coronary angiography were normal. The few reports of similar observations have not yielded a definite conclusion about the underlying pathophysiology of this electrocardiographic phenomenon. We reviewed the medical literature and hypothesize that manipulation of the intraseptal and left atrial ganglion plexuses by the transseptal needle and sheath causes an imbalance in autonomic innervation, which leads to coronary artery spasm and ST-segment elevation. Nonetheless, coronary artery air embolism during the transseptal approach should also be considered in the differential diagnosis. If the elevation is transient and there is no evidence of acute myocardial infarction, we believe that careful monitoring and evaluation are more appropriate than immediate termination of the ablation procedure.
Bao H Le; James N Black; Shoei K Stephen Huang
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital     Volume:  37     ISSN:  1526-6702     ISO Abbreviation:  Tex Heart Inst J     Publication Date:  2010  
Date Detail:
Created Date:  2011-01-12     Completed Date:  2011-04-22     Revised Date:  2013-07-02    
Medline Journal Info:
Nlm Unique ID:  8214622     Medline TA:  Tex Heart Inst J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  717-21     Citation Subset:  IM    
Section of Cardiac Electrophysiology & Pacing, Division of Cardiology, Department of Internal Medicine, Scott & White Memorial Hospital, Texas A&M University Health Science Center, Temple, Texas 76508, USA.
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MeSH Terms
Atrial Fibrillation / physiopathology,  surgery*
Autonomic Nervous System / physiopathology
Bradycardia / etiology
Cardiac Catheterization / adverse effects*
Catheter Ablation*
Coronary Angiography
Coronary Vasospasm / etiology*,  physiopathology,  radiography
Hypotension / etiology
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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