Transient ST segment elevation due to coronary slow flow during cryoballoon application [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. Ahead of Print: TKDA-95898 | DOI: 10.5543/tkda.2017.95898

Transient ST segment elevation due to coronary slow flow during cryoballoon application

Tumer Erdem Guler, Tolga Aksu, Kazim Serhan Ozcan, Serdar Bozyel
Kocaeli Derince Education And Research Hospital, Department Of Cardiology, Kocaeli, Turkey

Herein, we presented a rare case who experienced transient ST segment elevation during cryoballoon application for paroxysmal atrial fibrillation (PAF). A 74-year old male with symptomatic PAF was referred to our center for ablation. During cryo-ablation of the left superior pulmonary vein (at 188 s, -48°C), ST segment elevation in anterolateral leads was abruptly observed without any significant complaint. Upon the increase of ST segment elevation, cryo-application was immediately stopped. Coronary artery angiography was performed less than 5 minutes after balloon deflation and showed coronary slow flow with corrected the Thrombolysis In Myocardial Infarction (TIMI) frame count of 48.4 (normal range 21±3) to the left anterior descending artery (LAD). There was no significant flow-limiting lesion, coronary vasospasm, thromboembolus or air embolus in any coronary vessel. The TIMI frame count for the right coronary artery and the circumflex artery were normal. The ST segment elevation gradually returned to baseline in 14 minutes, without any intervention. Control TIMI frame count of LAD was 22. It was decided not to repeat cryo-application in this vein because there was entrance and exit block. The other 3 PVs were then isolated uneventfully. The patient was discharged from the hospital the next day without symptoms or ECG changes.

Keywords: Ablation, atrial fibrillation, myocardial infarction, tachycardia

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Corresponding Author: Tolga Aksu, Türkiye
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