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Akutes Koronarsyndrom nach Katheterablation von Vorhofflattern

Acute coronary syndrome after catheter ablation of atrial flutter

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Intensivmedizin und Notfallmedizin

Summary

A 52-year old engineer with recurrent tachycardia and palpitations in the history, appeared with a sustained tachycardia (heart rate 137 beats per minute) in an emergency room. A narrow QRS complex tachycardia (QRS width <0.12 s) with regular RR-intervals and negative flutter waves in leads II, III and aVF was visible in the 12-lead surface electrocardiogram and allowed the diagnosis of “common type” atrial flutter (Aflut). After delivery of a 200 J biphasic DC-shock, the tachycardia stopped immediately and sinus rhythm with normal rate was present. Due to several risk factors, coronary angiography with normal findings was performed prior to catheterization (CA) of Aflut. Radiofrequency (RF) CA was performed in the same session without any problems and 18 RF energies between the right inferior (tricuspid valve) and the vena cava inferior leading to a bidirectional block. During a 30 min waiting period, the patient suffered from angina pectoris at rest, responsibly from nitroglycerin. The immediately performed coronary angiography revealed a subtotal stenosis of the right coronary artery (RCA) close to the crux cordis. Percutaneous coronary intervention with angioplasty and T-stenting was performed with an excellent result. During the mean follow-up of 6 months, the patient is doing fine without any signs of CAD or Aflut.

Zusammenfassung

Ein 52-jähriger Ingenieur, der seit Jahren über rezidivierende Palpitationen und paroxysmale Tachykardien klagt, wird bei anhaltender regelmäßiger Tachykardie vorgestellt. Im 12-Kanal-Oberflächen-EKG findet sich ein Vorhofflattern (VHFl) vom „gewöhnlichen Typ“ mit sägezahnartiger P-Wellen-Morphologie in den inferioren Ableitungen II, III und aVF und einer Kammerfrequenz von 137/ min. Terminierung durch externe DC-Kardioversion. Bei vorliegendem kardiovaskulärem Risikoprofil Durchführung einer Koronarangiographie vor Katheterablation des VHFl mit Ausschluß einer koronaren Herzerkrankung. In gleicher Sitzung unkomplizierte Vorhofflatterablation mit 18 Energieabgaben am rechts inferioren Isthmus zwischen Trikuspidalklappe und Vena cava inferior. Hierdurch Induktion eines bidirektionalen Leitungsblockes als Ausdruck einer erfolgreichen Katheterablation. Während einer 30-minütigen Wartezeit nach Katheterablation Entwicklung einer Ruhe-Angina-pectoris. Sofortige Darstellung der Koronararterien und Nachweis einer subtotalen Stenosierung der rechten Koronararterie (RCA) im Bereich der Crux cordis. Sofortige Wiederherstellung der RCA-Perfusion in Doppeldraht-, und „kissing-ballon“ Technik, T-Stenting auf die Crux cordis mit sehr gutem angiographischem Primärergebnis und sofortiger und im Langzeitverlauf anhaltender Beschwerdefreiheit des Patienten.

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Authors and Affiliations

  1. Medizinische Klinik II (Schwerpunkte Kardiologie und Angiologie), Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Germany

    A. Meissner, R. Borchard, C. Müller, C. Perings & H.-J. Trappe

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  1. A. Meissner
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  2. R. Borchard
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  3. C. Müller
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  4. C. Perings
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  5. H.-J. Trappe
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Correspondence to A. Meissner.

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Meissner, A., Borchard, R., Müller, C. et al. Akutes Koronarsyndrom nach Katheterablation von Vorhofflattern. Intensivmed 43, 134–142 (2006). https://doi.org/10.1007/s00390-006-0659-4

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  • DOI: https://doi.org/10.1007/s00390-006-0659-4

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