Coronary ischemia induced by radiofrequency ablation in the left atrium.
BACKGROUND
We report three cases of transient, reversible coronary ischemia occurring after radiofrequency ablation in the left atrium.


RESULTS
A 56-year-old man with a left atrial tachycardia that was mapped to the septum and roof of the atrium using a noncontact mapping developed 5-mm ST elevation in the anterolateral leads. Coronary angiography showed an occluded diagonal that was opened using intracoronary nitrate, which led to resolution of the ST changes. A 57-year-old man undergoing right upper pulmonary vein ablation developed 6-mm ST elevation in leads V1-V4, II, III, and aVF. Coronary angiography showed normal coronaries with slow flow into the left anterior descending artery, which resolved with nitrates. A 50-year-old man undergoing left lower pulmonary vein ablation developed 3-mm reversible inferior ST elevation. All patients were adequately anticoagulated after transseptal access to the left atrium.


CONCLUSIONS
Ablation in the left atrium, at the roof, septum, and left inferior wall, can cause transient coronary ischemia, possibly due to spasm, which can be reversed with intracoronary nitrates. This phenomenon has not been previously described.
Simon
Ron D B
RD
Department of Adult Cardiology, Guy's and St. Thomas' Hospital NHS Trust, London, United Kingdom. rsimon@auberlac.aflex.net
Gill
Jaswinder S
JS
D001281:Atrial Fibrillation / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000209:etiology*