Catheter ablation related mitral valve injury: The importance of early recognition and rescue mitral valve repair

Christopher V. Desimone, Tiffany Hu, Elisa Ebrille, Faisal F. Syed, Vaibhav R. Vaidya, Yong-Mei Cha, Arturo M. Valverde, Paul Andrew Friedman, Rakesh M. Suri, Samuel J Asirvatham

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Mitral Valve Injury with Catheter Ablation. Introduction: An increasing number of catheter ablations involve the mitral annular region and valve apparatus, increasing the risk of catheter interaction with the mitral valve (MV) complex. We review our experience with catheter ablation-related MV injury resulting in severe mitral regurgitation (MR) to delineate mechanisms of injury and outcomes.

Methods:We searched theMayo Clinic MV surgical database over a 19-year period (1993-2012) and the electrophysiologic procedures database over a 23-year period (1990-2013) and identified 9 patients with catheter ablation related MV injury requiring clinical intervention.

Results: Indications for ablation included atrial fibrillation (AF) [n = 4], ventricular tachycardia (VT) [n = 3], and left-sided accessory pathways [n = 2]. In all 4 AF patients, a circular mapping catheter entrapped in the MV apparatus was responsible for severe MR. In all 3 VT patients, radiofrequency energy delivery led to direct injury to the MV apparatus. In the 2 patients with accessory pathways, both mechanisms were involved (1 per patient). Six patients required surgical intervention (5 MV repair, 1 catheter removal). One patient developed severe functional MR upon successful endovascular catheter disentanglement that improved spontaneously. Two VT patients with persistent severe postablation MR were managed nonsurgically, 1 of whom died 3 months postprocedure.

Conclusion: Circular mapping catheter entrapment and ablation at the mitral annulus are the most common etiologies of MV injury during catheter ablation. Close surveillance of the MV is needed during such procedures and early surgical repair is important for successful salvage if significant injury occurs.

Original languageEnglish (US)
Pages (from-to)971-975
Number of pages5
JournalJournal of Cardiovascular Electrophysiology
Volume25
Issue number9
DOIs
StatePublished - 2014

Fingerprint

Catheter Ablation
Mitral Valve
Wounds and Injuries
Mitral Valve Insufficiency
Ventricular Tachycardia
Catheters
Atrial Fibrillation
Databases

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Mitral valve damage
  • Ventricular tachycardia
  • WPW syndrome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Catheter ablation related mitral valve injury : The importance of early recognition and rescue mitral valve repair. / Desimone, Christopher V.; Hu, Tiffany; Ebrille, Elisa; Syed, Faisal F.; Vaidya, Vaibhav R.; Cha, Yong-Mei; Valverde, Arturo M.; Friedman, Paul Andrew; Suri, Rakesh M.; Asirvatham, Samuel J.

In: Journal of Cardiovascular Electrophysiology, Vol. 25, No. 9, 2014, p. 971-975.

Research output: Contribution to journalArticle

Desimone, Christopher V. ; Hu, Tiffany ; Ebrille, Elisa ; Syed, Faisal F. ; Vaidya, Vaibhav R. ; Cha, Yong-Mei ; Valverde, Arturo M. ; Friedman, Paul Andrew ; Suri, Rakesh M. ; Asirvatham, Samuel J. / Catheter ablation related mitral valve injury : The importance of early recognition and rescue mitral valve repair. In: Journal of Cardiovascular Electrophysiology. 2014 ; Vol. 25, No. 9. pp. 971-975.
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abstract = "Mitral Valve Injury with Catheter Ablation. Introduction: An increasing number of catheter ablations involve the mitral annular region and valve apparatus, increasing the risk of catheter interaction with the mitral valve (MV) complex. We review our experience with catheter ablation-related MV injury resulting in severe mitral regurgitation (MR) to delineate mechanisms of injury and outcomes.Methods:We searched theMayo Clinic MV surgical database over a 19-year period (1993-2012) and the electrophysiologic procedures database over a 23-year period (1990-2013) and identified 9 patients with catheter ablation related MV injury requiring clinical intervention.Results: Indications for ablation included atrial fibrillation (AF) [n = 4], ventricular tachycardia (VT) [n = 3], and left-sided accessory pathways [n = 2]. In all 4 AF patients, a circular mapping catheter entrapped in the MV apparatus was responsible for severe MR. In all 3 VT patients, radiofrequency energy delivery led to direct injury to the MV apparatus. In the 2 patients with accessory pathways, both mechanisms were involved (1 per patient). Six patients required surgical intervention (5 MV repair, 1 catheter removal). One patient developed severe functional MR upon successful endovascular catheter disentanglement that improved spontaneously. Two VT patients with persistent severe postablation MR were managed nonsurgically, 1 of whom died 3 months postprocedure.Conclusion: Circular mapping catheter entrapment and ablation at the mitral annulus are the most common etiologies of MV injury during catheter ablation. Close surveillance of the MV is needed during such procedures and early surgical repair is important for successful salvage if significant injury occurs.",
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AU - Desimone, Christopher V.

AU - Hu, Tiffany

AU - Ebrille, Elisa

AU - Syed, Faisal F.

AU - Vaidya, Vaibhav R.

AU - Cha, Yong-Mei

AU - Valverde, Arturo M.

AU - Friedman, Paul Andrew

AU - Suri, Rakesh M.

AU - Asirvatham, Samuel J

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N2 - Mitral Valve Injury with Catheter Ablation. Introduction: An increasing number of catheter ablations involve the mitral annular region and valve apparatus, increasing the risk of catheter interaction with the mitral valve (MV) complex. We review our experience with catheter ablation-related MV injury resulting in severe mitral regurgitation (MR) to delineate mechanisms of injury and outcomes.Methods:We searched theMayo Clinic MV surgical database over a 19-year period (1993-2012) and the electrophysiologic procedures database over a 23-year period (1990-2013) and identified 9 patients with catheter ablation related MV injury requiring clinical intervention.Results: Indications for ablation included atrial fibrillation (AF) [n = 4], ventricular tachycardia (VT) [n = 3], and left-sided accessory pathways [n = 2]. In all 4 AF patients, a circular mapping catheter entrapped in the MV apparatus was responsible for severe MR. In all 3 VT patients, radiofrequency energy delivery led to direct injury to the MV apparatus. In the 2 patients with accessory pathways, both mechanisms were involved (1 per patient). Six patients required surgical intervention (5 MV repair, 1 catheter removal). One patient developed severe functional MR upon successful endovascular catheter disentanglement that improved spontaneously. Two VT patients with persistent severe postablation MR were managed nonsurgically, 1 of whom died 3 months postprocedure.Conclusion: Circular mapping catheter entrapment and ablation at the mitral annulus are the most common etiologies of MV injury during catheter ablation. Close surveillance of the MV is needed during such procedures and early surgical repair is important for successful salvage if significant injury occurs.

AB - Mitral Valve Injury with Catheter Ablation. Introduction: An increasing number of catheter ablations involve the mitral annular region and valve apparatus, increasing the risk of catheter interaction with the mitral valve (MV) complex. We review our experience with catheter ablation-related MV injury resulting in severe mitral regurgitation (MR) to delineate mechanisms of injury and outcomes.Methods:We searched theMayo Clinic MV surgical database over a 19-year period (1993-2012) and the electrophysiologic procedures database over a 23-year period (1990-2013) and identified 9 patients with catheter ablation related MV injury requiring clinical intervention.Results: Indications for ablation included atrial fibrillation (AF) [n = 4], ventricular tachycardia (VT) [n = 3], and left-sided accessory pathways [n = 2]. In all 4 AF patients, a circular mapping catheter entrapped in the MV apparatus was responsible for severe MR. In all 3 VT patients, radiofrequency energy delivery led to direct injury to the MV apparatus. In the 2 patients with accessory pathways, both mechanisms were involved (1 per patient). Six patients required surgical intervention (5 MV repair, 1 catheter removal). One patient developed severe functional MR upon successful endovascular catheter disentanglement that improved spontaneously. Two VT patients with persistent severe postablation MR were managed nonsurgically, 1 of whom died 3 months postprocedure.Conclusion: Circular mapping catheter entrapment and ablation at the mitral annulus are the most common etiologies of MV injury during catheter ablation. Close surveillance of the MV is needed during such procedures and early surgical repair is important for successful salvage if significant injury occurs.

KW - Atrial fibrillation

KW - Catheter ablation

KW - Mitral valve damage

KW - Ventricular tachycardia

KW - WPW syndrome

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