Author + information
- Received December 13, 2016
- Revision received January 11, 2017
- Accepted January 20, 2017
- Published online October 16, 2017.
- Alexey Tsyganov, MDa,∗ (, )
- Svetlana Fedulova, MD, PhDb,
- Sergey Mironovich, MDa,
- Angelina Dzeranova, MDb and
- Ekaterina Fetisova, MDa
- aDepartment of Cardiac Electrophysiology, Petrovsky National Research Centre of Surgery, Moscow, Russia
- bIntraoperative Echocardiographic Service, Petrovsky National Research Centre of Surgery, Moscow, Russia
- ↵∗Address for correspondence:
Dr. Alexey Tsyganov, Department of Cardiac Electrophysiology, Petrovsky National Research Centre of Surgery, Abrikosovsky Per. 2, Moscow 119991, Russia.
A 53-year-old woman with a history of sustained symptomatic ventricular tachycardia proceeded to catheter ablation. Endocardial electroanatomic mapping revealed ectopic focus in the posteroseptal right ventricular (RV) outflow tract. Focal radiofrequency ablations using outputs of 30 W of the earliest activation site were performed using irrigated tip ablation catheter. No “steam pops” were observed, although the catheter got stuck in the RV free wall during electroanatomic mapping. Two h after the procedure, the patient suddenly complained of severe chest pain. Transthoracic echocardiography (TTE) in parasternal long-axis view demonstrated a large 4 × 2 cm–sized subepicardial hematoma in the RV free wall without communication to the RV cavity and a small pericardial effusion. Magnetic resonance imaging confirmed the initial diagnosis. Although the RV wall hematoma was large enough to rupture, conservative management option was decided based on his stable vital sign and tolerable chest pain. Repeated TTE revealed no changes in the size of hematoma. A final TTE at 12 weeks after ablation procedure showed a complete resolution of the hematoma (Figure 1, Online Videos 1, 2, 3, and 4).
A cardiac wall hematoma is a rare but potentially life-threatening complication of the interventional procedure. The management of cardiac wall hematoma is based mainly on the few case reports of its occurrence (1,2). This presentation demonstrates that conservative management with serial TTE is preferred in cases where the hematoma is not encroaching on cardiac chambers.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received December 13, 2016.
- Revision received January 11, 2017.
- Accepted January 20, 2017.
- 2017 American College of Cardiology Foundation
- de Vos A.M.,
- van der Schaaf R.J.
- Degrauwe S.,
- Monney P.,
- Muller O.,
- Ruchat P.,
- Qanadli S.D.,
- Eeckhout E.,
- Iglesias J.F.