PO-04-056 NOT ALL POST-ABLATION CHEST PAIN IS PERICARDITIS: THE IMPORTANCE OF POST-PROCEDURE MONITORING

Coronary artery injury is a rare, but serious complication of ablation. To describe case in which left inferolateral accessory pathway (AP) targeted via the great cardiac vein (GCV) was complicated by subacute circumflex occlusion requiring drug eluting stent (DES). N/A A 62-year-old male with palpitations due to atrio-ventricular reciprocating tachycardia setting Wolff-Parkinson-White syndrome presented our institution for repeat He had undergone two unsuccessful ablations 2005. More recently, he experienced refractory recurrences prompting multiple emergency room visits. angiogram performed one month prior ablation revealed non-obstructive coronary disease. His baseline ECG showed sinus rhythm preexcitation suggestive AP. In EP lab, orthodromic and antidromic reentrant induced. Ablation at 4 o’clock on mitral annulus transeptal approach failed eliminate pathway. The GCV were thoroughly mapped (Panel B) shortest VA time found GCV. Visualization intracardiac echocardiogram (ICE) suggested safe distance from artery. Radiofrequency (RF) applied this site successfully eliminated antegrade retrograde AP conduction. patient lab stable condition. After less than hour recovery, reported brief episode chest pain. Upon review telemetry, transient ST elevation ventricular ectopy noted A), suggesting vasospasm. underwent angiography, 99% stenosis mid-left C) DES placed. Echocardiogram following morning demonstrated normal LVEF no regional wall motion abnormalities. An exercise stress test three months later preexcitation, myocardial perfusion, evidence flow-limiting stenosis. Although known ablation, particularly when RF venous circulation. Despite ICE imaging, occlusion. Our highlights risk such approach, as well importance judicious monitoring post-procedure setting. should be high differential diagnosis presence pain complex arrhythmias immediate recovery period.