Intramyocardial Hematoma During Catheter Ablation for Scar-Related Ventricular Tachycardia.
catheter ablation
dissecting ventricular hematoma
steam pop
ventricular intramural hematoma
ventricular tachycardia
Journal
JACC. Clinical electrophysiology
ISSN: 2405-5018
Titre abrégé: JACC Clin Electrophysiol
Pays: United States
ID NLM: 101656995
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
received:
14
04
2023
revised:
20
06
2023
accepted:
05
07
2023
medline:
1
12
2023
pubmed:
27
8
2023
entrez:
26
8
2023
Statut:
ppublish
Résumé
Intramural hematoma during ablation for scar-related ventricular tachycardia (VT) is a rare but life-threatening complication. The goal of this study was to describe the features and outcomes of intramural hematoma during ablation for scar-related VT. From 2010 to 2022, >3,514 ablations for ventricular arrhythmias were performed at 2 institutions. Four cases of intramural hematoma complicating VT ablation for scar-related VT were identified. Intraprocedural details, imaging data, and surgical notes were reviewed to create a recognizable pattern of events highlighting this complication. In 3 of 4 cases, intramural hematoma occurred during catheter ablation with an open irrigated 3.5 mm tipped catheter using normal saline for irrigation. In one case, hematoma was noted after ablation using an investigational needle electrode catheter. The occurrence of a steam pop preceded detection of an expanding intramural hematoma in 3 cases. ST-segment elevation on electrocardiography was evident in 3 cases; intracardiac echocardiographic imaging detected the hematoma in all cases. Epicardial rupture and pericardial effusion requiring drainage occurred in 3 cases, whereas 1 hematoma was self-contained and did not require intervention. Surgical intervention was performed in 2 cases, with successful outcomes. One patient who was deemed not a surgical candidate died of progressive cardiogenic shock. Intramural hematoma during ablation for scar-related VT is a rare but potentially catastrophic complication that requires prompt recognition. Steam pops during ablation frequently precede the hematoma formation. Surgical intervention may be life-saving, although contained hematomas can occasionally be managed conservatively.
Sections du résumé
BACKGROUND
BACKGROUND
Intramural hematoma during ablation for scar-related ventricular tachycardia (VT) is a rare but life-threatening complication.
OBJECTIVES
OBJECTIVE
The goal of this study was to describe the features and outcomes of intramural hematoma during ablation for scar-related VT.
METHODS
METHODS
From 2010 to 2022, >3,514 ablations for ventricular arrhythmias were performed at 2 institutions. Four cases of intramural hematoma complicating VT ablation for scar-related VT were identified. Intraprocedural details, imaging data, and surgical notes were reviewed to create a recognizable pattern of events highlighting this complication.
RESULTS
RESULTS
In 3 of 4 cases, intramural hematoma occurred during catheter ablation with an open irrigated 3.5 mm tipped catheter using normal saline for irrigation. In one case, hematoma was noted after ablation using an investigational needle electrode catheter. The occurrence of a steam pop preceded detection of an expanding intramural hematoma in 3 cases. ST-segment elevation on electrocardiography was evident in 3 cases; intracardiac echocardiographic imaging detected the hematoma in all cases. Epicardial rupture and pericardial effusion requiring drainage occurred in 3 cases, whereas 1 hematoma was self-contained and did not require intervention. Surgical intervention was performed in 2 cases, with successful outcomes. One patient who was deemed not a surgical candidate died of progressive cardiogenic shock.
CONCLUSIONS
CONCLUSIONS
Intramural hematoma during ablation for scar-related VT is a rare but potentially catastrophic complication that requires prompt recognition. Steam pops during ablation frequently precede the hematoma formation. Surgical intervention may be life-saving, although contained hematomas can occasionally be managed conservatively.
Identifiants
pubmed: 37632506
pii: S2405-500X(23)00516-9
doi: 10.1016/j.jacep.2023.07.004
pii:
doi:
Substances chimiques
Steam
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2303-2314Informations de copyright
Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.