Coronary Artery Injury Related To Catheter Ablation of Cardiac Arrhythmias: A Systematic Review.

INTRODUCTION: Catheter ablation has emerged as the preferred modality of treatment for many cardiac arrhythmias. Anatomical sites of ablation are often located in close proximity to coronary arteries. However, the incidence of catheter ablation related coronary injury has not been well studied. We sought to systematically evaluate all cases of catheter ablation related coronary injuries.

METHODS AND RESULTS: A PUBMED search was conducted from inception until May 1, 2017 using the key words 'coronary artery' and 'ablation.' We identified 2,817 published articles of which 43 articles met our inclusion criteria representing 61 cases of coronary artery injury attributed to catheter ablation procedures from 1992 to 2017. Posteroseptal accessory pathway ablation was associated with the highest incidence of coronary injury (35.6% of cases), followed by cavotricuspid isthmus dependent flutter (19.3%). The right coronary artery was the site of injury in over two-thirds of all reported cases. Coronary injury was detected intra-procedurally in about half of the cases (43.1%), whereas it was a delayed presentation in the other half. Coronary intervention was performed in a third of all cases (32.7%). There were a total of 3 deaths attributed to coronary artery injury.

CONCLUSIONS: Most (91.8%) coronary injuries are a result of anatomic proximity to the site of ablation. Awareness of the relation between coronary artery course and anatomical site of ablation could prevent myocardial damage and improve procedural safety. This article is protected by copyright. All rights reserved.