Bezold-Jarisch-like reflex during Brockenbrough's procedure for radiofrequency catheter ablation of focal left atrial fibrillation: report of two cases.
Brockenbrough's puncture technique has been widely conducted in the electrophysiologic laboratory. We report here two cases exhibiting a rare complication of this procedure, which arose during the conduct of catheter ablation using radiofrequency energy delivered to the pulmonary vein for the treatment of focal left atrial fibrillation. These cases exhibited marked sinus bradycardia and profound hypotension, suggestive of a Bezold-Jarisch-like reflex, observed immediately after Brockenbrough's procedure but before radiofrequency application. ST elevation in the inferior leads was also observed in spite of normal coronary angiograms. This unanticipated transient complication was treated by intravenous administration of atropine, which had no influence on the ablation procedure or prognosis. This is speculated to be attributable to the elevation of vagal tone caused by the mechanical effects of transseptal puncture on the interatrial vagal network.
Arita
Takeshi
T
Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan. arita@intmed1.med.kyushu-u.ac.jp
Kubota
Satoko
S
Okamoto
Kazuhiko
K
Kuma
Fumiaki
F
Nakasuga
Kazuta
K
Koga
Hideyuki
H
Ito
Hiroyuki
H
Maruyama
Toru
T
Kaji
Yoshikazu
Y
Harada
Mine
M
D000328:Adult; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D001919:Bradycardia / Q000209:etiology; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods*; D004562:Electrocardiography; D006801:Humans; D007022:Hypotension / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012021:Reflex, Abnormal; D014630:Vagus Nerve / Q000503:physiopathology