title: Bezold-Jarisch-like reflex during Brockenbrough's procedure for radiofrequency catheter ablation of focal left atrial fibrillation: report of two cases.
abstract: 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.
authors.affiliation: Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan. arita@intmed1.med.kyushu-u.ac.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Arita
authors.forename: Satoko
authors.initials: S
authors.lastname: Kubota
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Okamoto
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Kuma
authors.forename: Kazuta
authors.initials: K
authors.lastname: Nakasuga
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Koga
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ito
authors.forename: Toru
authors.initials: T
authors.lastname: Maruyama
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Kaji
authors.forename: Mine
authors.initials: M
authors.lastname: Harada
mesh_terms: 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