Author + information
- Received September 4, 2018
- Revision received October 16, 2018
- Accepted November 1, 2018
- Published online March 18, 2019.
- Hiroshi Hayashi, MD, PhDa,∗ (, )
- Yu-ki Iwasaki, MD, PhDa,
- Masato Hachisuka, MDa,
- Rei Mimuro, MDa,
- Yujin Maru, MDa,
- Yuhi Fujimoto, MD, PhDa,
- Eiichiro Oka, MDa,
- Satsuki Noma, MDa,
- Hideto Sangen, MDa,
- Teppei Yamamoto, MD, PhDa,
- Yukichi Tokita, MD, PhDa,
- Kenji Yodogawa, MD, PhDa,
- Masamichi Takano, MD, PhDb,
- Hitoshi Takano, MD, PhDa and
- Wataru Shimizu, MD, PhDa
- aDepartment of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
- bDepartment of Cardiovascular Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
- ↵∗Address for correspondence:
Dr. Hiroshi Hayashi, Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
A 54-year-old man underwent catheter ablation of premature ventricular contractions (PVCs). Catheter ablation was performed under deep sedation. The activation mapping of the PVCs revealed a centrifugal pattern, and the earliest activation site of the PVCs was located on the right ventricular outflow tract septum. After successfully eliminating the PVCs, the electrocardiogram exhibited ST-segment elevation in the precordial leads. An emergent coronary angiography revealed a total occlusion of the mid-left anterior descending (LAD) artery (Figure 1A). After restoration of blood flow (Figure 1B), the Fourier domain optical coherence tomography (FD-OCT) revealed a marked diffuse shrinkage of the mid-distal LAD artery and luminal narrowing with a localized swelling of the vessel wall close to the area where the ablation had been performed (Figure 2). The FD-OCT also showed the loss of the media at the site with no intimal disruption, suggesting that the radiofrequency energy had affected the lesion. An emergent percutaneous stent implantation was successfully performed.
One year after the procedure, a coronary computed tomography angiography was performed as a follow-up, which revealed an in-stent restenosis and total occlusion of the LAD artery. We integrated the electroanatomic map of the ablated PVCs into the coronary computed tomography angiography by using the CARTO Merge feature (Biosense Webster, Inc., Diamond Bar, California) (Figure 1C). Some of the ablation sites were adjacent to the proximal edge of the stent implanted in the LAD artery.
The right ventricular outflow tract and LAD artery are in close anatomic relation to each other. Although we did not confirm the location of the LAD artery by intracardiac echocardiography imaging, attention should be paid to the anatomic relationship between the LAD artery and the ablation site. Using intracardiac echocardiographic imaging will provide us the real-time anatomic distance between the ablation site and the coronary artery, which will prevent a clinically devastating complication.
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 September 4, 2018.
- Revision received October 16, 2018.
- Accepted November 1, 2018.
- 2019 American College of Cardiology Foundation