07 July 2019 : Case report
Iatrogenic Arteriovenous Fistula and Atrial Septal Defect Following Cryoballoon Ablation for Atrial Fibrillation – Two Correctable Causes of Right Heart Failure
Diagnostic / therapeutic accidents
Katarzyna Dudzińska-Szczerba1ABDEF*, Roman Piotrowski1AB, Beata Zaborska1B, Ewa Pilichowska-Paszkiet1B, Małgorzata Sikora-Frąc1B, Anna Żuk1B, Paweł Lewandowski1B, Piotr Kułakowski1E, Jakub Baran1ABCDEDOI: 10.12659/AJCR.916205
Am J Case Rep 2019; 20:971-974
Abstract
BACKGROUND: Catheter ablation for atrial fibrillation is an important therapeutic intervention. One of the most frequent complications of this procedure is vascular issues including arteriovenous fistula. Iatrogenic atrial septal defect (IASD) has been reported as a complication of transseptal puncture; however, no data are available demonstrating any coexistent of arteriovenous fistula with IASD.
CASE REPORT: A 61-year-old female patient was admitted to our center for catheter ablation for persistent atrial fibrillation. Her past medical history was significant for cryoballoon ablation for atrial fibrillation in 2015, which was subsequently complicated by hematoma and arteriovenous fistula at puncture site. After general surgery consultation, the patient was qualified for conservative treatment. To exclude left atrial thrombus before redo procedure, transesophageal echocardiography was performed which visualized the presence of 9-mm atrial septal defect with left-to-right shunting, detecting right-to-left shunting using Valsalva maneuver. No significant valvular abnormalities were identified. The next day, pulmonary vein isolation for atrial fibrillation was performed. One month later, a control transthoracic echocardiogram (TTE) revealed hemodynamic significant left-to-right shunting with Qp/Qs 2.0 and high probability of pulmonary hypertension. Vascular surgery for arteriovenous fistula was successfully performed in October 2018. Subsequent TTE, performed a month later, confirmed no left-to-right shunting and no signs of pulmonary hypertension or diminishment of the right atrium.
CONCLUSIONS: Vascular access during catheter ablation for atrial fibrillation may result in arteriovenous fistula. This condition might affect right atrium pressure leading to increased diameter of previous puncture site at the interatrial septum, causing IASD with significant shunting. In this group of patients, arteriovenous fistula should be treated as soon as possible.
Keywords: Arteriovenous Fistula, Atrial Fibrillation, Catheter Ablation, Heart Septal Defects, Atrial, Cryosurgery, Echocardiography, Transesophageal, Iatrogenic Disease, Postoperative Complications, Vascular Surgical Procedures
In Press
26 Mar 2024 : Case report
Intrabiliary Rupture of a Hepatic Hydatid Cyst: A Case ReportAm J Case Rep In Press; DOI: 10.12659/AJCR.943893
27 Mar 2024 : Case report
Surgical Correction of Ischiopagus Tripus Conjoined Twins with Fused Pelvis: Enhancing Quality of Life thro...Am J Case Rep In Press; DOI: 10.12659/AJCR.942126
27 Mar 2024 : Case report
A 16-Year-Old Girl with Sinonasal Cutaneous Fistula Following Excision and Radiotherapy for Rhabdomyosarcom...Am J Case Rep In Press; DOI: 10.12659/AJCR.943098
27 Mar 2024 : Case report
Congenital Dislocation of the Knee in the Delivery RoomAm J Case Rep In Press; DOI: 10.12659/AJCR.943725
Most Viewed Current Articles
07 Mar 2024 : Case report
Neurocysticercosis Presenting as Migraine in the United StatesDOI :10.12659/AJCR.943133
Am J Case Rep 2024; 25:e943133
10 Jan 2022 : Case report
A Report on the First 7 Sequential Patients Treated Within the C-Reactive Protein Apheresis in COVID (CACOV...DOI :10.12659/AJCR.935263
Am J Case Rep 2022; 23:e935263
19 Jul 2022 : Case report
Atlantoaxial Subluxation Secondary to SARS-CoV-2 Infection: A Rare Orthopedic Complication from COVID-19DOI :10.12659/AJCR.936128
Am J Case Rep 2022; 23:e936128
23 Feb 2022 : Case report
Penile Necrosis Associated with Local Intravenous Injection of CocaineDOI :10.12659/AJCR.935250
Am J Case Rep 2022; 23:e935250