Massive Air Embolism in the Left Atrial Appendage During Radiofrequency Atrial Fibrillation Ablation: A Case Report

Document Type : Case Report

Authors

1 Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

2 Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, IR Iran.

Abstract

Background: Air embolism is a complication of electrophysiological procedures, including atrial fibrillation (AF) ablation. Despite the benign course of air embolism in most patients, it can be a life-threatening event due to systemic air embolism to the coronary or brain circulation. Interruption of blood to vital organs may lead to serious damage.
Case: A 77-year-old woman with a history of AF in the preceding 8 years was a candidate for AF ablation due to symptomatic persistent AF following the discontinuation of flecainide. Massive air embolism during catheter ablation developed in the left atrial appendage (LAA). Aspiration with a pigtail catheter through the trans-septal sheath was not successful, but the air was evacuated using the Judkins right catheter without any permanent complications.
Conclusions: An operator must be au fait with all technical aspects of air embolism management. End-hole catheters may be more effective for the aspiration of aeroembolism in the LAA than multi-orifice pigtail catheters. (Iranian Heart Journal 2023; 24(2): 100-103)

Keywords


  1. Patterson MS, Kiemeneij F. Coronary air embolism treated with aspiration catheter. Heart 2005; 91(5):e36.
  2. Wang YF, Cen XJ, Yu JW, Qu BM, Wang LH. Aeroembolism in left atrium during catheter ablation of atrial fibrillation in a patient with dextrocardia: a case report and review of the literature. BMC Cardiovascular Disorders. 2017 Dec; 17(1):1-5.
  3. Ahmad K, Asirvatham S, Kamath S, Peck S, Liu X. Successful interventional management of catastrophic coronary arterial air embolism during atrial fibrillation ablation. Heart Rhythm Case Rep 2015; 2:153–6.
  4. Phifer TJ, Bridges M, Conrad SA. The residual central venous catheter track- an occult source of lethal air embolism. J Trauma. 1991; 31:1558–60.
  5. Tang R-B, Dong J-Z, Long D-Y, et al. Incidence and clinical characteristics of transient ST-T elevation during transseptal catheterization for atrial fibrillation ablation. Europace 2014; 17:579–83.
  6. Do DH, Khakpour H, Krokhaleva Y, Mori S, Bradfield J, Boyle NG, Shivkumar K. Massive Air Embolism During Atrial Fibrillation Ablation: Averting Disaster in a Time of Crisis. Case Reports. 2021 Jan 1; 3(1):47-52.
  7. Kuwahara T, Takahashi A,Takahashi Y,etal.Clinical characteristics of massive air embolism complicating left atrial ablation of atrial fibrillation: lessons from five cases. Europace 2011; 314:204–208.
  8. Voci P, Yang Y, Greco C, Nigri A, Critelli G. Coronary air embolism complicating accessory pathway catheter ablation: detection by echocardiography. J Am Soc Echocardiogr 1994; 7:312–4.
  9. McCarthy CJ, Behravesh S, Naidu SG, Oklu R. Air embolism: practical tips for prevention and treatment. Journal of Clinical Medicine. 2016 Nov; 5(11):93.
  10. Colley PS, Artu AA. Bunegin-albino catheter improves air retrieval and resuscitation from lethal air embolism in up-right dogs. Anesth Analg.1989; 68:298–301.
  11. Lesh MD, Coggins DL, Ports TA. Coronary air embolism complicatin gtrans- septal radio frequency ablation of left free-wall accessory path ways. Pacing Clin Electrophysiol 1992; 15:1105–1108.