2023 Volume 87 Issue 3 Pages 464-
An 82-year-old man with a structurally normal heart had frequent premature ventricular contractions ([PVCs] Figure A). He underwent radiofrequency catheter ablation for PVCs originating from the posterior papillary muscles with the CARTO3® system and a contact force-sensing ablation catheter (Thermocool Smart Touch Surround FlowTM; Biosense Webster, Inc., CA, USA). An intracardiac echocardiography (ICE) catheter (SoundStarTM; Biosense Webster) was used to produce ICE images of the left ventricle (LV). Settings were as follows: 30 W power, 5–20 g (mean: 12.4; SD: 2.7) contact force, 19–48 s duration (total: 582; mean: 32; SD: 7.9) 357–555 (mean: 468; SD: 52) ablation index (Figure B,C). No audible or silent steam pop was observed. He recovered uneventfully without cardiac tamponade or other complications, but 1 month later, echocardiography showed a pseudoaneurysm in the ablation area despite no apparent symptoms. Different from pre-ablation (Figure D), cardiac computed tomography (CT) and magnetic resonance imaging (MRI) scans (Figure E,F) also showed the pseudoaneurysm (1.2×1.1 cm). Delayed gadolinium enhancement in MRI showed patterns commonly found with subendocardial damage (Figure G; Supplementary Movie). Because the pseudoaneurysm’s size was unchanged on 3-month follow-up CT, we continued watchful waiting. This case illustrates that LV pseudoaneurysm can occur in an asymptomatic patient after uneventful catheter ablation on the posterior wall.
(A) Premature ventricular contractions (PVCs) on 12-lead ECG. (B) Papillary muscles seen on the intracardiac echocardiography images and marked on CARTO3. (C) Integration of fixed left ventriculography into the CARTO3 system. Circles indicate the ablation points. Pre-ablation (D) and (E) post-ablation cardiac computed tomography. (F) Post-ablation and (G) delayed gadolinium enhancement magnetic resonance imaging.
The authors declare no conflicts of interest.
Supplementary Movie. Cine-mode cardiac MRI.
Please find supplementary file(s);
https://doi.org/10.1253/circj.CJ-22-0553
