Acute myocardial infarction due to a coronary embolus during left atrial ablation for persistent atrial fibrillation.

摘要

Catheter ablation is increasingly used to treat symptomatic patients with atrial fibrillation (AF). We report a rare case of embolization to the left anterior descending artery, which was successfully treated by thrombectomy. A 49-year-old man underwent ablation for persistent AF. Transoesophageal echocardiography did not demonstrate an intracardiac thrombus. Following trans-septat punctures, heparin was administered to maintain an activated clotting time between 300 and 350 s. Isolation of all four pulmonary veins was performed followed by complex fractionated atrial electrogram ablation using a Thermacool irrigated tip ablation (Biosense Webster) catheter. Following this, ST-segment elevation was seen across the anterior chest leads. Coronary angiography demonstrated a thrombus in the left anterior descending artery associated with TIMI 1 flow (see figure). Aspiration of the thrombus was carried out using an EXPORT (Medtronic) catheter. Repeat angiography showed restoration of TIMI3 flow, which was associated with resolution of the ST-segments. He remained well with no further complications.