Life-threatening left atrial wall hematoma secondary to a pulmonary vein laceration: an unusual complication of catheter ablation for atrial fibrillation.
BACKGROUND
Several complications may occur during catheter ablation for atrial fibrillation (AF). We report an unusual case of left atrial wall hematoma without pericardial effusion secondary to a right inferior pulmonary vein (PV) laceration. The use of real-time transesophageal echocardiography (TEE) during the procedure can be useful for early detection of this potentially lethal complication.


METHODS
A 49-year-old woman was referred for AF ablation. Her past medical history included severe systemic lupus with chronic renal failure treated with immunosuppressive and steroid drugs. A TEE-guided hybrid approach for AF ablation was performed with circular PV lesions and antrum and ostial electrical isolation. While performing the mitral isthmus line, the TEE showed a growing hematoma at the posterior left atrial wall. Rapidly, left atrium (LA) collapse associated with hemodynamic compromise occurred without any pericardial effusion. The patient was brought to the operating room. No pericardial effusion was seen at the time of surgery. The cardiac exploration showed a right inferior PV laceration. The visual inspection of the LA revealed thin and friable tissue. The patient survived. After 25 months of follow-up, she is still free from symptomatic AF.


CONCLUSIONS
Left atrial wall hematoma without pericardial effusion is a rare and life-threatening complication after catheter-based AF ablation. TEE is a valuable monitoring tool to accurately diagnose several acute complications and prompt rapid intervention.
Echahidi
Najmeddine
N
Laval Hospital, Quebec Heart Institute, Quebec, Canada. najmeddine.echahidi@crhl.ulaval.ca
Philippon
François
F
O'Hara
Gilles
G
Champagne
Jean
J
D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery; D017115:Catheter Ablation / Q000009:adverse effects*; D005260:Female; D006325:Heart Atria / Q000293:injuries*; D006335:Heart Injuries / Q000175:diagnosis / Q000209:etiology*; D006408:Hematoma, Subdural / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D011667:Pulmonary Veins / Q000293:injuries* / Q000601:surgery*; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000209:etiology*