AI Article Synopsis
- Brockenbrough's puncture technique is commonly used in electrophysiology labs, but two cases highlight a rare complication during catheter ablation for left atrial fibrillation.
- Both cases experienced severe bradycardia and hypotension, resembling the Bezold-Jarisch reflex, right after the puncture but before applying radiofrequency energy.
- The issue was resolved with atropine, which did not affect the ablation process or outcomes, potentially due to increased vagal tone from the puncture's mechanical impact on the interatrial vagal network.
Article 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.
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| http://dx.doi.org/10.1023/a:1023917221763 | DOI Listing |
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