Jetzt ist alles aus!

Komplikationen im EPU-Labor und ihre Lösungen

It’s all over!

Complications in the EP lab and their solutions

Zusammenfassung

In der Rhythmologie stehen zunehmend komplexe Prozeduren den immer stärker prozessoptimierten Abläufen gegenüber. Dies stellt insbesondere Elektrophysiologinnen und Elektrophysiologen in der Ausbildung vor Herausforderungen, da sie nicht nur lernen müssen, den Eingriff durchzuführen, sondern auch mit möglichen Komplikationen umzugehen. Der vorliegende Artikel zeigt anhand mehrerer exemplarischer Fallbeispiele, wie Komplikationen kontrolliert oder vermieden werden können. Die Fallserie behandelt Komplikationen wie die Luftembolie bei linksatrialen Prozeduren, iatrogene Gefäßverletzungen wie eine Aortendissektion oder Dissektion des Koronarvenensinus, Komplikationen und Herausforderungen bei Elektrodenrevisionen sowie die Perikardtamponade. Zu jedem Fall werden Maßnahmen zur Vermeidung sowie Handlungsempfehlungen zum Management der jeweiligen Komplikation aufgezeigt.

Abstract

In cardiac electrophysiology, invasive procedures like catheter ablations or device implantations are getting increasingly complex. This poses challenges especially for electrophysiologists in training, not only to learn how to perform the procedure, but also how to manage possible complications. The present article uses exemplary case studies to present how to control complications and how to avoid them. The presented cases deal with complications such as air embolism in left atrial procedures, iatrogenic vascular injuries such as aortic dissection or dissection of the coronary sinus, complications and challenges with lead revisions, and pericardial tamponade. In each case, measures for avoidance as well as practical guidance for management are shown when the respective complication occurs.

This is a preview of subscription content, log in to check access.

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8
Abb. 9
Abb. 10
Abb. 11
Abb. 12

Literatur

  1. 1.

    Adler S, van den Berg JC, Bertoglio L et al (2019) Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS). Eur J Cardiothorac Surg 55:133–162

    Article  Google Scholar 

  2. 2.

    Ahmad K, Asirvatham S, Kamath S et al (2016) Successful interventional management of catastrophic coronary arterial air embolism during atrial fibrillation ablation. HeartRhythm Case Rep 2:153–156. https://doi.org/10.1016/j.hrcr.2015.12.003

    Article  PubMed  Google Scholar 

  3. 3.

    Beyls C, Hermida A, Duchateau J et al (2019) Management of acute cardiac tamponade by direct autologous blood transfusion in interventional electrophysiology. J Cardiovasc Electrophysiol 30(8):1287–1293

    Article  Google Scholar 

  4. 4.

    Bongiorni MG, Proclemer A, Dobreanu D, Marinskis G, Pison L, Blomström-Lundqvist C, Todd D et al (2013) Preferred tools and techniques for implantation of cardiac electronic devices in Europe: results of the European Heart Rhythm Association survey. Europace 15(11):1664–1668. https://doi.org/10.1093/europace/eut345

    Article  PubMed  Google Scholar 

  5. 5.

    Chahine J, Baranowski B, Tarakji K, Gad MM, Saliba W, Rickard J, Hussein AA et al (2020) Cardiac venous injuries: Procedural profiles and outcomes during left ventricular lead placement for cardiac resynchronization therapy. Heart Rhythm. https://doi.org/10.1016/j.hrthm.2020.03.011

    Article  PubMed  Google Scholar 

  6. 6.

    de Cock CC, van Campen CMC, Visser CA (2004) Major dissection of the coronary sinus and its tributaries during lead implantation for biventricular stimulation: Angiographic follow-up. Europace 6(1):43–47. https://doi.org/10.1016/j.eupc.2003.09.002

    Article  PubMed  Google Scholar 

  7. 7.

    De Martino G, Sanna T, Dello Russo A, Pelargonio G, Messano L, Ierardi C, Crea F et al (2004) A randomized comparison of alternative techniques to achieve coronary sinus cannulation during biventricular implantation procedures. J Interv Cardiac Electrophysiol 10(3):227–230. https://doi.org/10.1023/B:JICE.0000026916.15278.2e

    Article  Google Scholar 

  8. 8.

    Er F, Yüksel D, Hellmich M, Gassanov N (2015) Comparison of conventional versus steerable-catheter guided coronary sinus lead positioning in patients undergoing cardiac resynchronization device implantation. PLoS ONE 10(11):1–7. https://doi.org/10.1371/journal.pone.0143292

    CAS  Article  Google Scholar 

  9. 9.

    Erbel R, Aboyans V, Boileau C et al (2014) ESC Guidelines on the diagnosis and treatment of aortic diseases. Eur Heart J 35:2873–2926

    Article  Google Scholar 

  10. 10.

    Hsu J, Varosy P, Bao H, Dewland T, Curtis J, Marcus G (2013) Coronary sinus dissection from cardiac resynchronization therapy implantation and associated in-hospital adverse events: insights from the Ncdr. J Am Coll Cardiol 61(10):E654. https://doi.org/10.1016/s0735-1097(13)60654-3

    Article  Google Scholar 

  11. 11.

    Kirchhof P, Benussi S, Kotecha D et al (2016) 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 37:2893–2962. https://doi.org/10.1093/eurheartj/ehw210

    Article  Google Scholar 

  12. 12.

    Kottmaier M, Popa M, Bourier F et al (2020) Safety and outcome of very high-power short-duration ablation using 70 W for pulmonary vein isolation in patients with paroxysmal atrial fibrillation. Europace 22(3):388–393

    Article  Google Scholar 

  13. 13.

    Kuwahara T, Takahashi A, Takahashi Y et al (2012) Clinical characteristics of massive air embolism complicating left atrial ablation of atrial fibrillation: lessons from five cases. Europace 14:204–208. https://doi.org/10.1093/europace/eur314

    Article  PubMed  Google Scholar 

  14. 14.

    Levi M, Toh CH, Thachil J, Watson HG (2009) Guidelines for the diagnosis and management of disseminated intravascular coagulation. British committee for standards in haematology. Br J Haematol 145(1):24–33

    CAS  Article  Google Scholar 

  15. 15.

    Mahapatra S, Bybee KA, Bunch TJ, Espinosa RE, Sinak LJ, McGoon MD, Hayes DL (2005) Incidence and predictors of cardiac perforation after permanent pacemaker placement. Heart Rhythm 2(9):907–911. https://doi.org/10.1016/j.hrthm.2005.06.011

    Article  PubMed  Google Scholar 

  16. 16.

    Núñez-Gil IJ, Bautista D, Cerrato E et al (2015) Incidence, management, and immediate- and long-term outcomes after iatrogenic aortic dissection during diagnostic or Interventional coronary procedures. Circulation 131:2114–2119

    Article  Google Scholar 

  17. 17.

    Riambau V, Böckler D, Brunkwall J et al (2017) Editor’s choice—management of descending thoracic aorta diseases. Clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 53:4–52

    CAS  Article  Google Scholar 

  18. 18.

    Rottner L, Reissmann B, Schleberger R, Sinning C, Metzner A, Rillig A (2020) Management of acute complications during electrophysiological procedures. Herzschrittmacherther Elektrophysiol. https://doi.org/10.1007/s00399-020-00698-4

    Article  PubMed  Google Scholar 

  19. 19.

    Saremi F, Abolhoda A, Ashikyan O et al (2008) Arterial supply to sinuatrial and atrioventricular nodes: imaging with multidetector CT. Radiology 246:99–107. https://doi.org/10.1148/radiol.2461070030 (discussion 108–9)

    Article  PubMed  Google Scholar 

  20. 20.

    Su W, Kowal R, Kowalski M et al (2015) Best practice guide for cryoballoon ablation in atrial fibrillation: the compilation experience of more than 3000 procedures. Heart Rhythm 12:1658–1666. https://doi.org/10.1016/j.hrthm.2015.03.021

    Article  PubMed  Google Scholar 

  21. 21.

    Takami M, Fujiwara R, Kijima Y et al (2019) Techniques for reducing air bubble intrusion into the left atrium during radiofrequency catheter and cryoballoon ablation procedures: an ex vivo study with a high-resolution camera. Heart Rhythm 16:128–139. https://doi.org/10.1016/j.hrthm.2018.07.038

    Article  PubMed  Google Scholar 

  22. 22.

    Tokuda M, Kojodjojo P, Epstein LM et al (2011) Outcomes of cardiac perforation complicating catheter ablation of ventricular arrhythmias. Circ Arrhythm Electrophysiol 4(5):660–666

    Article  Google Scholar 

  23. 23.

    Ulus T, Babayiğit E, Çamlı E et al (2019) Early hyperbaric oxygen therapy for cerebral air embolism during atrial fibrillation ablation. Pacing Clin Electrophysiol 42:104–106. https://doi.org/10.1111/pace.13475

    Article  PubMed  Google Scholar 

  24. 24.

    Winkle RA, Mead RH, Engel G et al (2020) High-power, short-duration atrial fibrillation ablations using contact force sensing catheters: Outcomes and predictors of success including posterior wall isolation. Heart Rhythm. https://doi.org/10.1016/j.hrthm.2020.03.022

    Article  PubMed  Google Scholar 

  25. 25.

    Winkle RA, Moskovitz R, Mead HR et al (2018) Atrial fibrillation ablation using very short duration 50 W ablations and contact force sensing catheters. J Interv Card Electrophysiol 52(1):1–8

    Article  Google Scholar 

  26. 26.

    Yeshwant SC, Tsai MH, Jones BR et al (2017) Iatrogenic type A aortic dissection during idiopathic ventricular tachycardia ablation. Heart Rhythm Case Rep 3:396–399

    Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to PD Dr. med. David Duncker.

Ethics declarations

Interessenkonflikt

D. Duncker erhielt Vortragshonorare, Reisekostenunterstützung und/oder einen Fellowship grant von Abbott, Astra Zeneca, Bayer, Biotronik, Boehringer Ingelheim, Boston Scientific, Medtronic, Microport, Pfizer, Zoll. T. Dahme und A. Pott beziehen Vortragshonorare von Biosense Webster, Medtronic und Daiichi-Sankyo. A. Pott ist eingeladener Teilnehmer des Fellowships „Herzrhythmus“ von Boston Scientific. J. Schmitt gibt folgende Interessenskonflikte an: Speaker Bureau: Abbott, Bayer, Biotronik, BMS/Pfizer, Boston Scientific, CVRx, Daiichy Sankyo, Medtronic, Zoll CMS. Advisory Board: Biotronik, BMS/Pfizer. Scientific Grants: Abbott, Biotronik, Boston Scientific, CVRx, Medicalgorithmics, Zoll CMS. V. Kantenwein erhielt travel support from Sorin Group and Abbott Medical sowie Educational grants and training from Abbott Medical and Boston Scientific. J. Müller-Leisse erhielt Vortragshonorare, Reisekostenunterstützung und/oder einen Fellowship grant von Medtronic und Boston Scientific. C. Zormpas erhielt Reisekostenunterstützung und/oder einen Fellowship grant von Biotronik und Medtronic. V. Johnson erhielt Vortragshonorare, Reisekostenunterstützung und/oder einen Fellowship grant von Abott, Biotronik, Boston Scientific, BMS Pfizer und Zoll. C. Veltmann erhielt Vortragshonorare, Reisekostenuntersützung und/oder einen Fellowship grant von Abbott, Astra Zeneca, Bayer, Biotronik, Boehringer Ingelheim, Boston Scientific, Medtronic, Pfizer, Zoll. I. Deisenhofer, H. A. K. Hillmann, D. Palacios und T. Reents geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien. Für Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts, über die Patienten zu identifizieren sind, liegt von ihnen und/oder ihren gesetzlichen Vertretern eine schriftliche Einwilligung vor.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Duncker, D., Dahme, T., Deisenhofer, I. et al. Jetzt ist alles aus!. Herzschr Elektrophys (2020). https://doi.org/10.1007/s00399-020-00716-5

Download citation

Schlüsselwörter

  • Katheterablation
  • Deviceimplantation
  • Komplikationsmanagement
  • Patientensicherheit
  • Fallserie

Keywords

  • Catheter ablation
  • Device implantation
  • Complication management
  • Patient safety
  • Case series