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Myocardial Infarction During Radiofrequency Catheter Ablation in Wolff-Parkinson-White Syndrome: A Case Report

Authors:

D. Kuanova, Z. Tlegenova

Place of work:

  • Marat Ospanov West Kazakhstan Medical University, Aktobe, Kazakhstan

    • Reference link :

    Kuanova D, Tlegenova Z. Myocardial Infarction During Radiofrequency Catheter Ablation in Wolff-Parkinson-White Syndrome: A Case Report
    Abstract
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    Radiofrequency ablation (RFA) is a widely recognized, effective, and minimally invasive procedure for the radical treatment of paroxysmal tachycardia. However, rare complications, such as myocardial infarction (MI), can occur post-procedure.

    Purpose: to report a clinical case of MI following RFA in a patient with Wolff-Parkinson-White (WPW) syndrome and to analyze potential mechanisms and preventive measures.

    Methods. A 32-year-old male patient presented with frequent palpitations. Electrophysiological study revealed an accessory pathway with right inferior paraseptal localization. The patient underwent RFA, after which he experienced angina-like chest pain with ST-segment elevation on ECG and elevated troponin levels. Coronary angiography showed 60–65% stenosis in the distal third of the right coronary artery (RCA), with no significant lesions in other coronary arteries. The patient was managed conservatively and discharged in satisfactory condition after 7 days. A literature review was conducted using PubMed, Google Scholar, Web of Science, Scopus, and RSCI databases with keywords: "WPW syndrome," "radiofrequency ablation," and "myocardial infarction."

    Results. The incidence of MI following RFA is reported between 0.06% and 0.1%. Suggested mechanisms include coronary artery spasm, thermal injury to the coronary endothelium leading to acute or subacute thrombosis, and prolonged high-energy exposure near the coronary sinus. The risk of coronary artery injury is particularly high when the distance between the ablation site and the coronary artery is ≤2 mm, increasing the probability of damage to 50%.

    Conclusions. MI after RFA is more likely during procedures near the coronary sinus. Preventive strategies include detailed arrhythmia mapping, careful ablation technique, and experienced operators. In cases of coronary artery injury, timely percutaneous coronary intervention is critical for favorable outcomes.
    Keywords: simulation-based learning, medical education, innovative technologies, practical skills, medical university

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    Kuanova D.E. - https://orcid.org/0009-0007-2804-3431

    Tlegenova J.S. - http://orcid.org/0000-0002-3707-7365,SPIN 8403-4695

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