Angiography could avoid coronary lesions after ablation in youngsters with a posteroseptal pathway


Several case reports have documented coronary artery stenosis or even occlusion after radiofrequency energy ablation in children and adults. Coronary involvement early and late after radiofrequency ablation has also been described in animal models.

A study performed to assess prospectively the incidence of coronary artery injury early after catheter ablation for supraventricular tachycardias in children showed that artery narrowing adjacent to the ablation site was noted in two of 117 patients with an accessory pathway and occurred only in patients with a posteroseptal pathway. The study was published in the Volume 6, Issue 4, April 2009 of HeartRhythm.

From October 2002 to January 2008, 212 consecutive patients younger than 21 years with supraventricular tachycardias underwent selective coronary angiography before and 30 minutes after radiofrequency energy ablation or cryoablation.

Median patient age was 12 years (range .3-20.4 years), and median body weight was 47kg (range 5.5-130kg). An accessory pathway was diagnosed in 112 patients, AV nodal reentrant tachycardia (AVNRT) in 84 patients, and both an accessory pathway and AVNRT in 16 patients. Congenital heart disease was present in 31 patients.

In two of 117 patients who had radiofrequency ablation for an accessory pathway, an acute reduction in luminal diameter of the coronary artery adjacent to the ablation site was observed. These two patients with a structurally normal heart showed ST-segment changes with normalisation of the electrocardiogram within one week. Both were clinically asymptomatic, and two-dimensional echocardiography documented normal ventricular function. Noninvasive testing did not reveal any evidence of persistent myocardial ischaemia. No coronary artery damage was noted after ablation for AVNRT or after ablation with cryoenergy.

The authors of the study concluded that coronary angiography could be helpful in avoiding coronary lesions in patients with a posteroseptal pathway.