Incidence and clinical characteristics of transient ST-T elevation during transseptal catheterization for atrial fibrillation ablation

• Published in: Europace (London, England) Vol. 17; no. 4; pp. 579 - 583
• Main Authors: Tang, R.-B., Dong, J.-Z., Long, D.-Y., Yu, R.-H., Liu, X.-P., Cheng, Y.-L., Sang, C.-H., Ning, M., Jiang, C.-X., Avula, U. M. R., Bai, R., Liu, N., Ruan, Y.-F., Du, X., Ma, C.-S.
• Format: Journal Article
• Language: English
• Published: England 01.04.2015
• Subjects: Atrial Fibrillation - diagnosis; Atrial Fibrillation - epidemiology; Atrial Fibrillation - surgery; Cardiac Catheterization - statistics & numerical data; Catheter Ablation - statistics & numerical data; Causality; China - epidemiology; Female; Heart Septum - surgery; Humans; Incidence; Male; Middle Aged; Myocardial Infarction - diagnosis; Myocardial Infarction - epidemiology; Postoperative Complications - diagnosis; Postoperative Complications - epidemiology; Pulmonary Veins - surgery; Risk Assessment; Treatment Outcome; China; ST-T elevation; Transseptal catheterization; Atrial fibrillation; Catheter ablation
• ISSN: 1099-5129; 1532-2092; 1532-2092
• DOI: 10.1093/europace/euu278

Transient ST-T elevation (STE) is a rare complication that occurs during transseptal catheterization. This study aims to delineate the incidence and characteristics of transient STE during transseptal catheterization for atrial fibrillation (AF) ablation. Consecutive patients who underwent fluoroscopy-guided transseptal catheterization for circumferential pulmonary vein radiofrequency ablation in Beijing An Zhen Hospital from January 2006 to January 2013 were enrolled in this study. Out of 2965 patients with a total of 3452 transseptal catheterization procedures, 13 patients (0.38%, mean age 57 ± 8, 6 female, 12 paroxysmal AF, mean left atrial diameter 35.4 ± 3.8 mm) had STE. ST-T elevation occurred after transseptal puncture in 10 patients and after pulmonary vein venography in three patients. Systolic blood pressure (129 ± 10 vs. 104 ± 20 mmHg, P < 0.001), diastolic blood pressure (78 ± 6 vs. 64 ± 11 mmHg, P < 0.001), and heart rate (83 ± 19 bpm vs. 64 ± 23 b.p.m., P = 0.022) significantly decreased when STE occurred. Eleven patients complained of chest pain, one patient complained of dizziness, and one patient had no symptoms. Patients recovered in about 4.6 min (2-10 min) with dopamine or fast saline drip. Catheter ablation of AF was completed in all the 13 patients without sequelae or other complications. Four of the 13 patients (30.8%) had recurrence of AF after a mean follow-up of 21.7 months. ST-T elevation is a rare complication associated with transseptal catheterization without sequelae. Catheter ablation of AF could be safely completed in these patients.