Acquired arteriovenous fistula and chronic occlusion of the left anterior descending coronary artery in a patient with previous ablation of a left-sided accessory pathway

Abstract

Endocardial catheter ablation of accessory pathways is now considered as therapy of first choice in symptomatic patients. Success rates depend on the location of the accessory pathway itself and the operators experience in catheter ablation procedures. In patients with a left-sided pathway the retrograde transaortic catheter approach is used routinely in most centers. Besides occasional injuries of the vessels used for catheter placement and perforation of the cardiac chambers, there have been only a few case reports in the literature reporting rare procedure-specific complications such as catheter entrapment within the mitral valve apparatus and occlusion of the left circumflex coronary artery. We report a case of primary successful endocardial catheter ablation of a left lateral accessory pathway in a patient with normal coronary arteries at that time. Many years later progressive deterioration of systolic left ventricular function was observed. Coronary angiography revealed occlusion of LAD next to a arteriovenous (AV) fistula between the LAD and the anterior right ventricle. Endocardial catheter ablation was the only known cardiac manipulation in this patient raising the possibility that unintended catheter manipulations within the LAD had led to this rare and severe complication.