Acute massive pulmonary embolism after radiofrequency catheter ablation: a rare but devastating complication.

摘要

A 47-year-old man underwent radiofrequency catheter ablation because of recurrent paroxysmal supraventricular tachycardia. After the introduction of 2 venous sheaths into each side of the common femoral vein and 1 arterial sheath into the right femoral artery, typical slow-fast atrioventricular nodal re-entrant tachycardia (AVNRT) was induced, and the slow pathway was ablated uneventfully. The procedure lasted 120 minutes (fluoroscopic time, 14 min). Twenty hours later, the patient developed severe dyspnea, became cyanotic and hypoten-sive, and lost consciousness. Cardiopulmonary resuscitation was performed. Results of arterial blood gas examination showed a pH of 6.99, PaCO_2 of 53 mmHg, PaO_2 of 38 mmHg, bicarbonate of 12.8 mEq/L, and oxygen percent saturation of 41% with the patient on 50% oxygen through a Venturi mask. A 12-lead electrocardiogram revealed new-onset incomplete right bundle branch block, S_1Q_3 pattern, and acute-injury currents over the inferior leads (Figs. 1A and IB). In comparison with chest radiography upon hospital admission (Fig. 1C), repeat radiographs showed a large area of hypovolemia in the right lung (Fig. ID) and a prominent right descending pulmonary artery (Fig. IE). Echocardiography showed right ventricular dilation that compressed the left ventricle (Fig. 2A).