Can radiofrequency current isthmus ablation damage the right coronary artery? Histopathological findings following the use of a long (8 mm) tip electrode

WEISS, CHRISTIAN; BECKER, JAN; HOFFMANN, MATTHIAS; WILLEMS, STEPHAN

doi:10.1046/j.1460-9592.2002.00860.x

Cited by 39Cardiac Arrhythmias and TreatmentsCardiac pacing and defibrillation studiesCardiac electrophysiology and arrhythmias

Can radiofrequency current isthmus ablation damage the right coronary artery? Histopathological findings following the use of a long (8 mm) tip electrode

WEISS, CHRISTIAN, BECKER, JAN, HOFFMANN, MATTHIAS, WILLEMS, STEPHAN·2002·Pacing and Clinical Electrophysiology

DOI 10.1046/j.1460-9592.2002.00860.x

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Abstract

WEISS, C., et al. : Can Radiofrequency Current Isthmus Ablation Damage the Right Coronary Artery? Histopathological Findings Following the Use of a Long (8 mm) Tip Electrode. This report describes the histopathological findings following successful RF isthmus ablation for common atrial flutter in a 68‐years‐old man using a long 8‐mm tip ablation catheter. No acute complication was observed. The patient died 3 weeks after ablation due to severe heart failure and consecutive pneumonia. Lesion width (1.0 and 2.4 cm) and depth (0.4 and 0.8 cm) was measured. The right coronary artery showed an intramural hemorrhage adjacent to the side of the lesion. However, despite this finding no apparent injury of other layers of the coronary artery was detectable.

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Damage to the right coronary artery during cavotricuspid isthmus ablation is rare.
“while damage to the right coronary artery is rare.185”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [185]

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European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE)
Katritsis, D. G., Boriani, G., Cosio, F. G., Hindricks, G., Jaïs, P., Josephson, M. E., Keegan, R., Kim, Y.-H., Knight, B. P., Kuck, K.-H., et al. (2017) · Europace · doi:10.1093/europace/euw301 · Cited by 188 · see citing works
“Inappropriate extension of ablation to the septal RA can result in AV block,(183,184) while damage to the right coronary artery is rare.(185) Hemopericardium and tamponade may occur if very high power RF is applied, and if tissue ‘steam pop’ occurs.”
Background
The Inferior Right Atrial Isthmus: Further Architectural Insights for Current and Coming Ablation Technologies
Cabrera, J. Á., Sánchez‐Quintana, D., Farré, J., Campal, J. M. R., & Ho, S. Y. (2005) · Journal of Cardiovascular Electrophysiology · doi:10.1046/j.1540-8167.2005.40709.x · Cited by 138 · see citing works
Transcatheter cryoablation of tachyarrhythmias in children
Kirsh, J. A., Gross, G. J., O'Connor, S., & Hamilton, R. M. (2004) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2004.10.049 · Cited by 126 · see citing works
Catheter-Based Cryoablation Permanently Cures Patients With Common Atrial Flutter
Manusama, R., Timmermans, C. C., Limón, F., Philippens, S., Crijns, H. J. G. M., & Rodriguez, L. (2004) · Circulation · doi:10.1161/01.cir.0000124478.98343.00 · Cited by 83 · see citing works
Atrial Flutter, Typical and Atypical: A Review
Cosío, F. G. (2017) · Arrhythmia & Electrophysiology Review · doi:10.15420/aer.2017.5.2 · Cited by 143 · see citing works
“Damage to the right coronary artery is rare but can result in myocardial infarction in some cases with pre-existing coronary atherosclerotic lesions.(100,101) Cardiac perforation secondary to tissue disruption by boiling with audible ‘pops’ can occur when high energy is delivered with large-tip catheter-electrodes.”
Background
Right Coronary Artery Occlusion During RF Ablation of Typical Atrial Flutter
Mykytsey, A., Kehoe, R., Bharati, S., Maheshwari, P., Halleran, S., Krishnan, K., Razminia, M., Mina, A., & Trohman, R. G. (2010) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2009.01711.x · Cited by 34 · see citing works
Proximity of Coronary Arteries to the Atrioventricular Valve Annulus in Young Patients and Implications for Ablation Procedures
Al-Ammouri, I. A., & Perry, J. C. (2006) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2006.01.037 · Cited by 32 · see citing works
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Thyer, I. A., Kovoor, P., BARRY, M. A., Pouliopoulos, J., Ross, D. L., & Thiagalingam, A. (2006) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2006.00417.x · Cited by 29 · see citing works
Angiographic Analysis of the Anatomic Relation of Coronary Arteries to Mitral and Tricuspid Annulus and Implications for Radiofrequency Ablation
Hasdemir, C., Yavuzgil, O., Payzın, S., et al. (2007) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2007.03.082 · Cited by 29 · see citing works
Management of atrial fibrillation-flutter: uptodate guideline paper on the current evidence
Shah, S. R., Luu, S.-W., Calestino, M., David, J., & Bray, C. (2018) · Journal of Community Hospital Internal Medicine Perspectives · doi:10.1080/20009666.2018.1514932 · Cited by 26 · see citing works
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Simón, R., & Gill, J. S. (2003) · Journal of Cardiovascular Electrophysiology · doi:10.1046/j.1540-8167.2003.02474.x · Cited by 26 · see citing works
Radiofrequency Ablation of Atrial Flutter: A Randomized Controlled Trial of Two Anatomic Approaches
Passman, R. S., Kadish, A. H., Dibs, S. R., Engelstein, E. D., & Goldberger, J. J. (2004) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2004.00390.x · Cited by 24 · see citing works
Proximity of Right Coronary Artery to Cavotricuspid Isthmus as Determined by Computed Tomography
Aloul, B. A., Sigurðsson, G., Can, İ., et al. (2010) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2010.02844.x · Cited by 24 · see citing works
Atrial Coronary Arteries in Areas Involved in Atrial Fibrillation Catheter Ablation
Meo, J. P., Scanavacca, M., Sosa, E., Correia, A. T., HACHUL, D. T., Darrieux, F., Lara, S., Hardy, C. A., Jatene, F. B., & Jatene, M. B. (2010) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.110.951525 · Cited by 24 · see citing works
Histopathologic Background for Resistance to Conventional Catheter Ablation of Common Atrial Flutter
Igawa, O., Adachi, M., Hisatome, I., et al. (2004) · Journal of Cardiovascular Electrophysiology · doi:10.1046/j.1540-8167.2004.03447.x · Cited by 20 · see citing works
Radiofrequency ablation for common atrial flutter using an 8-mm tip catheter and up to 150W
HILLOCK, R., MELTON, I., & CROZIER, I. (2005) · Europace · doi:10.1016/j.eupc.2005.03.002 · Cited by 18 · see citing works
“Higher energies are also potentially associated with a higher risk of complications that can include coronary artery injury [13,14], pops, and cutaneous burns via incorrectly adhered RF patches [15].”
Background
Right Coronary Artery Damage during Cavotricuspid Isthmus Ablation
Caldwell, J. C., Fath-Odoubadi, F., & Garratt, C. J. (2010) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2010.02731.x · Cited by 18 · see citing works
“Discontinuing coronary sinus pacing revealed (1) ST elevation inferiorly despite the lack of chest pain and (2) no change in baseline atrial rate, suggesting the conduction delay was not simple due to increased vagal tone.”
Background
Acute Myocardial Infarction after Radiofrequency Catheter Ablation of Typical Atrial Flutter
Yune, S., Lee, W. J., Hwang, J., et al. (2014) · Journal of Korean Medical Science · doi:10.3346/jkms.2014.29.2.292 · Cited by 17 · see citing works
“To our knowledge, there have been five similar cases of right coronary artery occlusion during or after cavotricuspid isthmus ablation for typical atrial flutter (1-5), but the exact mechanism is still unclear.”
Background
Anatomical variations of the right coronary artery may be a source of difficult block and conduction recurrence in catheter ablation of common-type atrial flutter
Klemm, H. U., Weber, T. F., Johnsen, C., et al. (2010) · EP Europace · doi:10.1093/europace/euq320 · Cited by 16 · see citing works
“complications like RCA injury have only been reported as rare incidents.(7) We hypothesized that a cooling effect due to convection”
Background
Is Ablation of Atrial Flutter Always Safe?
Brembilla-Perrot, B., FILALI, M. L., Zinzius, P. Y., Sellal, J., Beurrier, D., Schwartz, J., de Chillou, C., Cismaru, G. L., & Pauriah, M. (2012) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2012.03464.x · Cited by 15 · see citing works
ST segment elevation and chest pain during cryoablation of atrial flutter
Johansson, B., Hrafnkelsdóttir, Þ. J., & Edvardsson, N. G. (2007) · EP Europace · doi:10.1093/europace/eum046 · Cited by 15 · see citing works
Ablação do flutter atrial típico: estudo prospectivo e randomizado do cateter irrigado fechado versus cateter com eletrodo distal de 8 mm
de Melo, S. L., Scanavacca, M., Darrieux, F., HACHUL, D. T., & Sosa, E. (2007) · Arquivos Brasileiros de Cardiologia · doi:10.1590/s0066-782x2007000300004 · Cited by 14 · see citing works
Performance of a New Cardiac Cryoablation System in the Treatment of Cavotricuspid Valve Isthmus‐Dependent Atrial Flutter
Daubert, J. P., HOYT, R. H., John, R. M., Chinitz, L. A., Martin, D. T., Fellows, C. L., Feld, G. K., Pelkey, W., Sehra, R., & CryoCor Atrial Flutter Investigators (2005) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2005.00094.x · Cited by 14 · see citing works
Catéter de 8 mm frente a punta irrigada en la ablación del flutter auricular dependiente del istmo: un estudio prospectivo y aleatorizado
Cuesta, A., Mont, L., Alvarenga, N., et al. (2009) · Revista Española de Cardiología · doi:10.1016/s0300-8932(09)71688-4 · Cited by 11 · see citing works
Atrial Flutter Ablation and Risk of Right Coronary Artery Injury
Aloul, B. A., Sigurðsson, G., Adabağ, S., et al. (2015) · Journal of Clinical Medicine Research · doi:10.14740/jocmr1986w · Cited by 9 · see citing works
“Pathological analysis of the patient’s RCA showed intramural hemorrhage adjacent to the side of the ablation lesion but without involvement of the other layers [7].”
Background
Mapping-guided ablation of the cavotricuspid isthmus: A novel simplified approach to radiofrequency catheter ablation of isthmus-dependent atrial flutter
Maruyama, M., Kobayashi, Y., Miyauchi, Y., Iwasaki, Y., Morita, N., Miyamoto, S., Tadera, T., Ino, T., Atarashi, H., Katoh, T., et al. (2006) · Heart Rhythm · doi:10.1016/j.hrthm.2006.02.008 · Cited by 9 · see citing works
Comparison of 8-mm-tip and Irrigated-tip Catheters in the Ablation of Isthmus-Dependent Atrial Flutter: A Prospective Randomized Trial
Cuesta, A., Mont, L., Alvarenga, N., Rogel, U., & Brugada, J. (2009) · Revista Española de Cardiología (English Edition) · doi:10.1016/s1885-5857(09)72355-2 · Cited by 9 · see citing works
Imaging Integration to Localize and Protect the Left Coronary Artery in Patients Undergoing LAAEI
Romero, J. E., Natale, A., Cerna, L. E., Lakkireddy, D., Díaz, J. C., Alviz, I., Grupposo, V., Rios, S. A., Chernobelsky, E., López-Cabanillas, N., et al. (2019) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2019.09.011 · Cited by 7 · see citing works
Unexpected AV Block During Cavotricuspid Isthmus Ablation
Pósán, E., Skanes, A. C., Gula, L. J., Klein, G. J., Yee, R. K., & Krahn, A. D. (2005) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2005.00201.x · Cited by 5 · see citing works
Invasive Elektrophysiologie: Komplikationen, Alpträume und deren Management
Reithmann, C., HAHNEFELD, A., Fiek, M., Ulbrich, M., & Steinbeck, G. (2007) · Herzschrittmachertherapie + Elektrophysiologie · doi:10.1007/s00399-007-0584-7 · Cited by 5 · see citing works
“beschrieben ein intramurales Hämatom der RCA als Autopsiebefund, nachdem der Patient drei Wochen nach erfolgreicher Isthmusablation (8 mm Ablationsspitze, Maximalenergie 70 W, maximale Zieltemperatur 65 C) an einer Pneumonie und schwerster Herzinsuffizienz verstorben war [42].”
Background
Right coronary artery wall edema provoked by cavotricuspid isthmus radiofrequency ablation
Nishimura, T., Goya, M., Shiohira, S., et al. (2017) · HeartRhythm Case Reports · doi:10.1016/j.hrcr.2017.07.010 · Cited by 3 · see citing works
Arrhythmias in Children and Patients with Congenital Heart Disease
Lopez, M. M., & Kanter, R. J. (2020) · Contemporary cardiology · doi:10.1007/978-3-030-41967-7_29 · Cited by 2 · see citing works
Katheterablation von Vorhofflattern
Gonska, B., Rab, J., & Zrenner, B. (2007) · Steinkopff eBooks · doi:10.1007/978-3-7985-1748-6_17 · Cited by 2 · see citing works
Acute Right Coronary artery Occlusion During Cooled-Tip Radiofrequency Ablation of the Cavotricuspid Isthmus
Castellanos, E., & Almendral, J. M. (2013) · Indian Pacing and Electrophysiology Journal · doi:10.1016/s0972-6292(16)30607-6 · Cited by 1 · see citing works
“Despite the proximity of the right coronary artery (RCA) to the CTI, only few reports of direct damage to the RCA resulting in myocardial infarction (MI) during CTI catheter ablation have been published [1-5].”
Arrhythmias in Children
Trivedi, B., & Kanter, R. J. (2010) · Humana Press eBooks · doi:10.1007/978-1-60761-161-5_17
Die Lagebeziehung der rechten Koronararterie zum cavo-trikuspidalen Isthmus und ihr Einfluss auf den Erfolg der Hochfrequenz-Katheterablation bei gewöhnlichem Vorhofflattern
Johnsen, C. (2014)
Ablação do istmo cavo-tricuspídeo para controle do flutter atrial: estudo prospectivo e randomizado comparando eficácia e segurança de cateter irrigado com cateter de 8 mm.
de Melo, S. L. (2005) · doi:10.11606/t.5.2005.tde-20102005-150207
A case of typical atrial flutter causing unexpected advanced atrioventricular block despite lateral cavotricuspid isthmus ablation
Mano, H., Okumura, Y., Watanabe, I., Nagashima, K., Nakai, T., Ohkubo, K., Kofune, T., Kofune, M., Sonoda, K., Haruta, H., et al. (2012) · Journal of Arrhythmia · doi:10.1016/j.joa.2012.05.006
“Besides catheter placement, there are 3 other potential mechanisms for AV block during CTI ablation.”
BackgroundInfluential
Asymptomatic coronary-atrial fistula formation after zero fluoro catheter ablation for incessant right atrial tachycardia using ABLATION INDEX module: case report
Кропоткин, Е. Б., Ivanitskiy, E. A., Tsaregorodtsev, A., et al. (2024) · Journal of Arrhythmology · doi:10.35336/va-1352

073_17093p Effects Of Different 3D Electro-Anatomic Mapping Systems On Fluoroscopy Exposure And Procedural Duration In Typical Atrial Flutter Ablation
Bastian, D., Serdoz, L. V., Poli, S., et al. (2017) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2017.09.017 · Cited by 1 · see citing works
Atrial flutter and atrial fibrillation ablation – sequential or combined? A cost-benefit and risk analysis of primary prevention pulmonary vein ablation
Gula, L. J., Skanes, A. C., Klein, G. J., Jenkyn, K. B., Redfearn, D., Manlucu, J., Roberts, J. D., Yee, R. K., TANG, A. S. L., & Leong‐Sit, P. (2016) · Heart Rhythm · doi:10.1016/j.hrthm.2016.02.018 · Cited by 21 · see citing works
Radiofrequency Ablation of Atrial Flutter Using Large‐Tip Electrode Catheters
Feld, G. K. (2004) · Journal of Cardiovascular Electrophysiology · doi:10.1046/j.1540-8167.2004.15104.x · Cited by 22 · see citing works
Recording of double atrial potentials as a marker for isthmus block during ablation of atrial flutter.
Batra, R., Nair, M., Babu, D. K. J., et al. (2001) · PubMed · Cited by 1 · see citing works
Perpendicular catheter orientation during papillary muscle ablation results in larger, deeper lesions
Nussinovitch, U., Wang, P. J., Narayan, S. M., et al. (2022) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.15408 · Cited by 7 · see citing works

Authors: WEISS, C., BECKER, J., HOFFMANN, M., & WILLEMS, S.
Affiliations: University Medical Center Hamburg-Eppendorf (DE)
Corresponding author: WEISS, CHRISTIAN
ORCID: HOFFMANN, MATTHIAS
WILLEMS, STEPHAN
Venue: Pacing and Clinical Electrophysiology
Publisher: Wiley
Published: 2002-05
Volume: 25
Issue: 5
Pages: 860-862
ISSN: 0147-8389 (ISSN-L)
1540-8159
DOI: 10.1046/j.1460-9592.2002.00860.x
OpenAlex: W2033427562
Cited by: 39
References: 0
Citations by year: 2024: 1 · 2020: 1 · 2019: 1 · 2018: 1 · 2017: 2 · 2016: 1 · 2015: 1 · 2014: 2 · 2013: 1 · 2012: 2
FWCI: 2.17
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor, 447 d)
Locations: Pacing and Clinical Electrophysiology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Keywords: radiofrequency catheter ablation, atrial flutter, common atrial flutter, intramural hematoma, histopathology, procedural complications
MeSH terms: Aged, Atrial Flutter, Coronary Vessels, Electrodes, Heart Failure, Humans, Male, Catheter Ablation, Fatal Outcome

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Can radiofrequency current isthmus ablation damage the right coronary artery? Histopathological findings following the use of a long (8 mm) tip electrode

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