Reviewing the echocardiography of the patient before surgery, the abnormal perforation in left ventricular-atrial was most likely caused by RFCA for the echocardiography before the procedure showed nothing wrong. And in our surgery, we performed a MVR and fixed the abnormal ventricular-atrial perforation via median sternotomy. At first, we did try a mitral valvuloplasty, however the coaptation height of the valve were only about 1~2 mm which was far from the required height of 4~8 mm, and the coaptation of the leaflets was still not restored when being checked with injection test. Considering postoperative long term effect of the patient, we thus chose to have the mitral valve replaced with a mechanical prosthesis. And the patient recovered well during follow-up.
Nowadays, cardiac radiofrequency ablation is a popular treatment for many kinds of arrhythmias [1], And the method is proved to be feasible and effective especially for symptomatic patients unresponsive to medical treatment [4], even announced as first line therapy for symptomatic supraventricular tachycardia [5]. However it does have some complications, some of which were even potentially life-threatening, for instance, cardiac tamponade. What’s more, some newly-presented complications associated with RFCA were identified, such as pulmonary vein stenosis and atrial-esophageal fistula [6]. Although this sort of major complications are rare and their rate is falling, an article published in 2012 reported that the overall complication rate after RFCA still ranged from 3.9 to 22% and major complications occurred in 3.9% of the patients [4]. Meanwhile the mortality of all patients who underwent RFCA procedures is about 0.1–0.2% [4]. We should improve our awareness to these complications and their causes. The reason may vary, it could be related with the use of high power or high temperature settings during radiofrequency delivery [2], or it might also be related to the site and type of ablation [1]. It is also reported that different anatomical and physiological circumstances might have the influence [2]. As RFCA is such a challenging and complex procedure, these factors should be carefully considered by both patients and physicians before surgery.
In addition, patients who are PSVT are possible to get tachycardia-induced AF after RFCA. And there is a study announced that whether remaining AF in post-ablation PSVT patients could be effectively predicted by the intra- and inter-atrial conduction delay [7]. It’s an overlooked etiology of PCIS since the widespread use of catheter-based procedures. Patients with small cardiac perforation during catheter ablation might develop PCIS, especially the elder or hypertensive patients.
Although cardiac perforation following a RFCA is rare, there is still 1% rate of ventricular ablation procedures. A timely surgical repair with cardiopulmonary bypass supported may help with the hemodynamic status of the patient. In this case, we emphasizes that these kind of uncommon complications associated with RFCA procedure should be paid attention to by the electrophysiologists.
For treatment, when a cardiac perforation is confirmed, a surgical repair is required for the majority of patients [8], and if a steam pop appeared and developed into cardiac tamponade, the surgical approach is even more in need [9]. It is also said that RFCA-associated pericardial effusion in patients treating arrhythmia is not rare and can easily lead to cardiac tamponade [10].
