Spontaneous Regression Of Submitral Pseudoaneurysm After Radiofrequency Catheter Ablation In A Patient With Wolff-parkinson-white Syndrome
Kim, D., & Lee, M. Y. (2018). Spontaneous regression of submitral pseudoaneurysm after radiofrequency catheter ablation in a patient with Wolff-Parkinson-White syndrome. HeartRhythm case reports, 4(12), 580–583. https://doi.org/10.1016/j.hrcr.2018.09.002
View Original Source →Abstract
Key Teaching Points•Left ventricular pseudoaneurysm is a rare complication of radiofrequency catheter ablation of Wolff-Parkinson-White syndrome.•The left ventricular pseudoaneurysm, manifesting as cardiac tamponade, occurred after hospital discharge.•Not all left ventricular pseudoaneurysms require cardiac surgery. Regression of a left ventricular pseudoaneurysm can be possible. •Left ventricular pseudoaneurysm is a rare complication of radiofrequency catheter ablation of Wolff-Parkinson-White syndrome.•The left ventricular pseudoaneurysm, manifesting as cardiac tamponade, occurred after hospital discharge.•Not all left ventricular pseudoaneurysms require cardiac surgery. Regression of a left ventricular pseudoaneurysm can be possible.
Case Details
Disease Location
Heart
Personal Characteristics
39-year-old male
Clinical Characteristics
Palpitations for the past 2 months. He had a diagnosis of paroxysmal svt at another hospital. Electrocardiogram showed subtle preexcitation that indicated a left-sided accessory pathway. Radiofrequency catheter ablation (rfca) was performed using a 4-mm-tip, nonirrigated conventional ablation catheter under temperature mode. Postprocedural echocardiography showed no pericardial effusion or valvular dysfunction. Twelve days later, the patient presented with sudden-onset syncope and chest discomfort. Chest CT showed large pericardial effusion. Urgent pericardiocentesis was performed. Drained fluid was bloody and consistent with hemorrhagic pericardial effusion. Follow-up computed tomography revealed a 2.7 ! 1.7-cm pseudoaneurysm without thrombus just beneath the posterior mitral annulus. Two-dimensional echocardiography showed the pseudoaneurysm with a small neck in the submittal area, which most likely was created by the ablation catheter. Color flow and doppler studies revealed systolic filling and diastolic emptying of the sac. The pericardial drain was removed after 8 days. Follow-up echocardiography showed no pericardial effusion, but the pseudoaneurysm was still observed.
Remission Characteristics
Serial computed tomographic and echocardiographic follow-up showed regression of the pseudoaneurysm.
Treatment & Mechanisms
Clinical Treatment
Rfca pericardiocentesis