Relevant Ventricular Septal Defect Caused by Steam Pop During Ablation of Premature Ventricular Contraction
2013; Lippincott Williams & Wilkins; Volume: 127; Issue: 24 Linguagem: Inglês
10.1161/circulationaha.112.130195
ISSN1524-4539
AutoresRobert Schönbauer, Philipp Sommer, Martín Misfeld, Borislav Dinov, Lukas Fiedler, Yan Huo, Thomas Gaspar, Ole A. Breithardt, Gerhard Hindricks, Arash Arya,
Tópico(s)Cardiac Structural Anomalies and Repair
ResumoHomeCirculationVol. 127, No. 24Relevant Ventricular Septal Defect Caused by Steam Pop During Ablation of Premature Ventricular Contraction Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBRelevant Ventricular Septal Defect Caused by Steam Pop During Ablation of Premature Ventricular Contraction Robert Schönbauer, MD, Philipp Sommer, MD, Martin Misfeld, MD, PhD, Borislav Dinov, MD, Lukas Fiedler, MD, Yan Huo, MD, Thomas Gaspar, MD, Ole-A. Breithardt, MD, Gerhard Hindricks, MD and Arash Arya, MD Robert SchönbauerRobert Schönbauer From the Departments of Electrophysiology (R.S., P.S., B.D., L.F., Y.H., T.G., O.B., G.H., A.A.) and Cardiac Surgery (M.M.), University of Leipzig, Heart Center, Leipzig, Germany. , Philipp SommerPhilipp Sommer From the Departments of Electrophysiology (R.S., P.S., B.D., L.F., Y.H., T.G., O.B., G.H., A.A.) and Cardiac Surgery (M.M.), University of Leipzig, Heart Center, Leipzig, Germany. , Martin MisfeldMartin Misfeld From the Departments of Electrophysiology (R.S., P.S., B.D., L.F., Y.H., T.G., O.B., G.H., A.A.) and Cardiac Surgery (M.M.), University of Leipzig, Heart Center, Leipzig, Germany. , Borislav DinovBorislav Dinov From the Departments of Electrophysiology (R.S., P.S., B.D., L.F., Y.H., T.G., O.B., G.H., A.A.) and Cardiac Surgery (M.M.), University of Leipzig, Heart Center, Leipzig, Germany. , Lukas FiedlerLukas Fiedler From the Departments of Electrophysiology (R.S., P.S., B.D., L.F., Y.H., T.G., O.B., G.H., A.A.) and Cardiac Surgery (M.M.), University of Leipzig, Heart Center, Leipzig, Germany. , Yan HuoYan Huo From the Departments of Electrophysiology (R.S., P.S., B.D., L.F., Y.H., T.G., O.B., G.H., A.A.) and Cardiac Surgery (M.M.), University of Leipzig, Heart Center, Leipzig, Germany. , Thomas GasparThomas Gaspar From the Departments of Electrophysiology (R.S., P.S., B.D., L.F., Y.H., T.G., O.B., G.H., A.A.) and Cardiac Surgery (M.M.), University of Leipzig, Heart Center, Leipzig, Germany. , Ole-A. BreithardtOle-A. Breithardt From the Departments of Electrophysiology (R.S., P.S., B.D., L.F., Y.H., T.G., O.B., G.H., A.A.) and Cardiac Surgery (M.M.), University of Leipzig, Heart Center, Leipzig, Germany. , Gerhard HindricksGerhard Hindricks From the Departments of Electrophysiology (R.S., P.S., B.D., L.F., Y.H., T.G., O.B., G.H., A.A.) and Cardiac Surgery (M.M.), University of Leipzig, Heart Center, Leipzig, Germany. and Arash AryaArash Arya From the Departments of Electrophysiology (R.S., P.S., B.D., L.F., Y.H., T.G., O.B., G.H., A.A.) and Cardiac Surgery (M.M.), University of Leipzig, Heart Center, Leipzig, Germany. Originally published18 Jun 2013https://doi.org/10.1161/CIRCULATIONAHA.112.130195Circulation. 2013;127:e843–e844A 62-year-old female patient with highly symptomatic, idiopathic, monomorphic, premature ventricular contraction presented at our institution for further treatment (Figure 1A). Previous medical antiarrhythmic treatment has failed. She had a history of mitral valve repair attributable to rheumatic heart disease 2 years before and paroxysmal atrial fibrillation. Aside from that, transthoracic echocardiogram revealed no structural heart disease. Indication was set for catheter ablation. After transseptal puncture (BRK-0 transseptal needle, St. Jude Medical, St. Paul, MN) a left ventricular electroanatomic activation map of the premature ventricular contraction was done using the CARTO-3 RMT system (Biosense-Webster, Diamond Bar, CA). The site of earliest activation was found in an inferoseptal apical position (Figure 1B and 1C). During radiofrequency ablation at this site with a 3.5-F external irrigated tip catheter (Navistar Thermocool, Biosense-Webster) with 50 W and max temperature of 46°C suddenly a loud steam pop occurred, together with an impedance drop of 34 Ω. However, blood pressure stayed stable for the rest of the procedure and pericardial effusion was ruled out immediately after steam pop, after the procedure, and the next day. The clinical premature ventricular contraction could successfully be terminated during ablation at the apical third of the left ventricular septum by a total of 54 radiofrequency ablation lesions. Two weeks later she presented again with progressive dyspnoea. An echocardiogram revealed a ventricular septal defect with distinctive left to right shunt (Figure 2, Movie I in the online-only Data Supplement). In ventriculogram shunt was quantified as 1.9/1 (Qp/Qs) (Figure 3, Movie II in the online-only Data Supplement) and indication was set for surgical repair. During on-pump cardiac surgery by median sternotomy a 1.5×3 cm inferoapical ventricular septal defect was closed by insertion of a 7×5 cm xenologic pericardial patch (Figure 4). Additionally, tricuspid valve was reconstructed by the use of a 30-mm Cosgrove-band (Edwards Lifesciences Corp, Irvine, CA). Five days after surgery the patient could be transferred from intensive care unit to ward. Further hospital stay was uneventful, and she was discharged on ninth postoperative day.Download figureDownload PowerPointFigure 1. A, Body surface 12-lead ECG of clinical premature ventricular contraction (PVC). B and C, Right and left anterior oblique projection (RAO and LAO) of successful ablation site, where also steam pop occurred. Abl indicates tip of ablation catheter; CS, coronary sinus; MA, mitral annulus; and RVA, catheter in right ventricular apex.Download figureDownload PowerPointFigure 2. Transesophageal echocardiographic short axis view of apical third of left and right ventricle without (A) and with (B) color-coded Doppler imaging, showing relevant left to right shunt. LV indicates left ventricle; and RV, right ventricle.Download figureDownload PowerPointFigure 3. Contrast ventriculography in left anterior oblique projection: snapshot of end of diastole (A) and end of systole (B) showing relevant left to right shunt. Black arrows mark the borders of apical ventricular septal defect. LV indicates left ventricle; MA, mitral annulus; and RV, right ventricle.Download figureDownload PowerPointFigure 4. A, After anterior left ventriculotomy, inferoapical 1.5×3 cm ventricular septal defect (VSD) is revealed. B, VSD is covered by 7×5 cm xenologic patch. VSD and patch are marked by white arrows.It is commonly perceived that the risk of cardiac perforation during ablation in the ventricle is relatively small compared with atrial ablation. The risk of perforation during ablation of atrial fibrillation is about 2.5%.1 On the other hand, the risk of ventricular perforation during ablation is ranging from 0.4% to 1.0%.2,3To the best of our knowledge this is the first reported case of ventricular septal defect, caused by catheter ablation of ventricular tachycardia. Most likely ventricular septal defect was associated with the steam pop during ablation at inferoapicoseptal position. Steam pops are infrequent in ventricular ablation and usually do not cause perforation. In a series of >4000 ablation lesions steam pops occurred in 62 lesions (1.5%) and cardiac perforation in only 1 of these cases (2%).4 Nevertheless, if perforation is caused by popping, the risk of need for surgical repair is higher, as it also was in this case.2DisclosuresNone.Footnotes*Drs Sommer and Misfeld contributed equally to this article.The online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl/doi:10.1161/CIRCULATIONAHA.112.130195/-/DC1.Correspondence to Robert Schönbauer, MD, University of Leipzig, Heart Center, Department of Electrophysiology, Strümpellstrasse 39, 04289 Leipzig, Germany. E-mail [email protected]References1. Bunch TJ, Asirvatham SJ, Friedman PA, Monahan KH, Munger TM, Rea RF, Sinak LJ, Packer DL. Outcomes after cardiac perforation during radiofrequency ablation of the atrium.J Cardiovasc Electrophysiol. 2005; 16:1172–1179.CrossrefMedlineGoogle Scholar2. Tokuda M, Kojodjojo P, Epstein LM, Koplan BA, Michaud GF, Tedrow UB, Stevenson WG, John RM. Outcomes of cardiac perforation complicating catheter ablation of ventricular arrhythmias.Circ Arrhythm Electrophysiol. 2011; 4:660–666.LinkGoogle Scholar3. Stevenson WG, Wilber DJ, Natale A, Jackman WM, Marchlinski FE, Talbert T, Gonzalez MD, Worley SJ, Daoud EG, Hwang C, Schuger C, Bump TE, Jazayeri M, Tomassoni GF, Kopelman HA, Soejima K, Nakagawa H; Multicenter Thermocool VT Ablation Trial Investigators. Irrigated radiofrequency catheter ablation guided by electroanatomic mapping for recurrent ventricular tachycardia after myocardial infarction: the multicenter thermocool ventricular tachycardia ablation trial.Circulation. 2008; 118:2773–2782.LinkGoogle Scholar4. Seiler J, Roberts-Thomson KC, Raymond JM, Vest J, Delacretaz E, Stevenson WG. Steam pops during irrigated radiofrequency ablation: feasibility of impedance monitoring for prevention.Heart Rhythm. 2008; 5:1411–1416.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Michaelis A, Dähnert I, Riede F, Paetsch I, Jahnke C, Paech C, Khan H, Sommer P, Ang R, Bernstein B and Kott K (2021) A case report: Amplatzer occluder device closure of an iatrogenic ventricular septal defect following radiofrequency ablation, European Heart Journal - Case Reports, 10.1093/ehjcr/ytab094, 5:4, Online publication date: 5-Apr-2021. Viles-Gonzalez J, Berjano E and d'Avila A (2018) Complications of Radiofrequency Catheter Ablation, JACC: Clinical Electrophysiology, 10.1016/j.jacep.2017.11.003, 4:4, (501-503), Online publication date: 1-Apr-2018. Trovati M and Bessis N (2015) An influence assessment method based on co-occurrence for topologically reduced big data sets, Soft Computing, 10.1007/s00500-015-1621-9, 20:5, (2021-2030), Online publication date: 1-May-2016. Behadada O, Trovati M, Chikh M and Bessis N (2015) Big data-based extraction of fuzzy partition rules for heart arrhythmia detection: a semi-automated approach, Concurrency and Computation: Practice and Experience, 10.1002/cpe.3428, 28:2, (360-373), Online publication date: 1-Feb-2016. Behadada O (2015) Fuzzy Partition Rules for Heart Arrhythmia Detection 2015 International Conference on Intelligent Networking and Collaborative Systems (INCOS), 10.1109/INCoS.2015.50, 978-1-4673-7695-2, (463-466) Behadada O (2015) Information Extraction from Unstructured Data Sets: An Application to Cardiac Arrhythmia Detection Big-Data Analytics and Cloud Computing, 10.1007/978-3-319-25313-8_9, (127-145), . Cochet H, Sacher F, Chaumeil A and Jais P (2014) Steam Pop During Radiofrequency Ablation, Circulation: Arrhythmia and Electrophysiology, 7:3, (559-560), Online publication date: 1-Jun-2014. Karkowski G, Kuniewicz M, Ząbek A, Koźluk E, Dębski M, Matusik P and Lelakowski J (2022) Contact Force-Sensing versus Standard Catheters in Non-Fluoroscopic Radiofrequency Catheter Ablation of Idiopathic Outflow Tract Ventricular Arrhythmias, Journal of Clinical Medicine, 10.3390/jcm11030593, 11:3, (593) June 18, 2013Vol 127, Issue 24 Advertisement Article InformationMetrics © 2013 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.112.130195PMID: 23775197 Originally publishedJune 18, 2013 PDF download Advertisement SubjectsArrhythmiasCardiovascular SurgeryCatheter Ablation and Implantable Cardioverter-Defibrillator
Referência(s)