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European Heart Journal 1995 16(5):647-650;
Copyright © 1995 by the European Society of Cardiology.
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© 1995 The European Society of Cardiology

Induction of transient third degree atrioventricular block during radiofrequency catheter ablation in a patient with ventricular tachycardia and remote myocardial infarction

H. KOTTKAMP, X. CHEN, G. HINDRICKS, S. WILLEMS, W. HAVERKAMP, T. WICHTER, G. BREITHARDT and M. BORGGREFE

Hospital of the Westfülische Wilhelms-University, Department of Cardiology and Angiology and Institute of Arteriosclerosis-Research Münster, Germany

revised 29 August 1994; accepted 5 September 1994.

Correspondence: Hans Kottkamp, MD, Westfälische Wilhelms-Universität Münster, Medizinische Klinik and Poliklinik, Innere Medizin C (Kardiologie and Angiologie), D-48129 Münster, Germany.

Abstract

INTRODUCTION: Radiofrequency catheter ablation has been demonstrated to be an effective and safe therapy in patients with so-called idiopathic ventricular tachycardia, whereas the benefit/risk profile for ablation of ventricular tachycardia in patients with chronic myocardial infarction and severely compromised left ventricular function still needs to be determined. The present report describes the unintended induction of transient third-degree atrioventricular block in a patient with remote myocardial infarction who underwent radiofrequency catheter ablation of ventricular tachycardia.

METHODS AND RESULTS: Endocardial catheter mapping and radiofrequency ablation were performed in a 57-year-old patient with chronic recurrent ventricular tachycardia, who had previously suffered from anterior and posterior wall myocardial infarction. Additionally, the patient presented with complete right bundle branch block during sinus rhythm. Radiofrequency energy applied to a critical site of the reentrant tachycardia at the left ventricular basal septum during sinus rhythm induced third-degree atrioventricular block after 20 s of current delivery, which lasted for 24 h. At this site, a presumable left bundle branch potential was recorded during sinus rhythm.

CONCLUSIONS: Radiofrequency current application for ablation of ventricular tachycardia may induce third-degree atrioventricular block in patients with remote myocardial infarction. When current is delivered to target sites at the left ventricular basal septum, radiofrequency energy should be applied during sinus rhythm to allow continuous monitoring of atrioventricular conduction. Special caution should be given to patients with right bundle branch block during sinus rhythm.

Key Words: Radiofrequency catheter ablation • ventricular tachycardia • atrioventricular block • myocardial infarction


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