title: Pulmonary embolism as a complication of an electrophysiological study: a case report.
abstract: BACKGROUND
  Electrophysiological studies have become an established practice in the evaluation and treatment of arrhythmias. Symptomatic pulmonary embolism as a result of deep vein thrombosis arising from multiple venous sheath femoral vein catheterization is an uncommon complication associated with it. We report the case of a 33-year-old woman who developed pulmonary embolism after an electrophysiological study, which was successfully treated at a cardiac hospital in Bangladesh.
  
  
  METHODS
  A 33-year-old Bangladeshi woman with hypertension and diabetes had initially presented with recurrent episodes of paroxysmal atrial fibrillation that manifested as palpitations for 2 years. Her atrial fibrillation was drug-refractory and could not be attributed to a treatable etiology. She had undergone an electrophysiological study at a different hospital, where right femoral venous catheterization was performed followed by the insertion of three venous sheaths. However, tachyarrhythmia could not be induced and a procedure to isolate the pulmonary vein was postponed because all the veins could not be isolated. Forty-eight hours later, she presented to our hospital with shortness of breath, chest heaviness, palpitations, and recurrent episodes of syncope. She had normal coronary arteries and no other risk factors for venous thromboembolism. She was hemodynamically stable on examination. There was echocardiographic evidence of pulmonary hypertension and right ventricular dilatation and dysfunction. A computed tomography pulmonary angiogram confirmed pulmonary embolus in the descending branch of her left pulmonary artery, extending up to the segmental arteries. Subsequently, a duplex ultrasound confirmed acute deep vein thrombosis affecting her right ilio-femoral segment. She was successfully managed with subcutaneous enoxaparin and oral warfarin (target international normalized ratio 2.5-3).
  
  
  CONCLUSIONS
  Pulmonary embolism is a rare but serious complication that may occur in patients who undergo electrophysiological studies. Multiple venous sheaths inserted into the femoral vein and catheter-induced endothelial injury, further compounded by prolonged procedural time, may be responsible for the increased thrombogenicity leading to deep vein thrombosis and subsequent pulmonary embolism. An adequate observation time after the procedure and clinical alertness are necessary for rapid diagnosis and treatment.
authors.affiliation: Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Dhaka, Bangladesh.
authors.forename: Sahela
authors.initials: S
authors.lastname: Nasrin
authors.affiliation: Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Dhaka, Bangladesh. aaysha.cader@gmail.com.
authors.forename: Fathima Aaysha
authors.initials: FA
authors.lastname: Cader
authors.affiliation: Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Dhaka, Bangladesh.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Salahuddin
authors.affiliation: Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Dhaka, Bangladesh.
authors.forename: Tahera
authors.initials: T
authors.lastname: Nazrin
authors.affiliation: Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Dhaka, Bangladesh.
authors.forename: Jabed
authors.initials: J
authors.lastname: Iqbal
authors.affiliation: Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Dhaka, Bangladesh.
authors.forename: Masuma Jannat
authors.initials: MJ
authors.lastname: Shafi
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000175:diagnosis; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D022062:Electrophysiologic Techniques, Cardiac / Q000009:adverse effects; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000209:etiology*; D018616:Ultrasonography, Doppler, Duplex; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology*
keywords: Deep vein thrombosis; Electrophysiological study; Pulmonary Embolism