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The complication rate of radiofrequency catheter ablation varies depending on patient characteristics and treatment, and has been reported to be approximately 3%. Esophageal irritation is one significant complication of catheter ablation, and its most common result is atrio-esophageal fistulae. However, rarely, unexpected complications and clinical variants occur due to irritation of the vagal nerve or peri-esophageal tissue without fistula formation. In this case report, attention is drawn to this rare complication in two cases, one of which occurred after paraseptal-epicardial accessory pathway ablation, and the other after atrial fibrillation ablation. Both were symptomatic with severe gag reflex.

We report on a 42-year-old female patient with inappropriate sinus tachycardia (IST), in whom an effective sinus node modification was made by using the noncontact mapping system. The patient was admitted with palpitations and a heart rate between 90-110 beats per minute (bpm). Her heart rate increased to 150 bpm during minimal exercise. After confirming the diagnosis of IST by an electrophysiological study, radiofrequency catheter ablation was performed. A color-coded isopotential map was created when the heart rate was 95 bpm and the initial breakthrough of the sinus node (SNB) was labeled. After administration of isoproterenol, a new color-coded map recording was created when the heart rate reached 160 bpm, showing a new breakthrough 24 mm away from the SNB. Radiofrequency was delivered to this region and the heart rate decreased to 120 bpm. After another infusion of isoproterenol, the maximum heart rate reached 140 bpm and another isopotential map recording was created, which demonstrated migration of the breakthrough 16 mm away from the SNB. Radiofrequency was delivered to the second site and the heart rate decreased to 90 bpm and increased to a maximum of 120 bpm after a new isoproterenol infusion. A subsequent infusion caused no increase in the heart rate, and the ablation procedure was terminated. During a follow-up of one year, the patient was in sinus rhythm with a mean heart rate of 80 bpm.

A 52-year-old man with left atrial tachycardia underwent radiofrequency catheter ablation. A steerable 4-mm-tip ablation catheter was advanced into the left atrium through a patent foramen ovale without transseptal puncture. However, the tip of the catheter was stuck in a structure. A pull-back maneuver rendered the catheter free and the procedure was cancelled. Transthoracic and transesophageal echocardiograms obtained immediately after the procedure showed intimal layer dissection in the interatrial septum and intramural hematoma formation throughout the anterior left atrial wall. The patient was in stable condition. Therefore, he was followed-up conservatively with serial echocardiographic examinations. The dissected intimal layer disappeared in 10 days and the hematoma underwent near-complete resolution in three months. This case highlights a rare complication of catheter ablation procedure that all interventionists should be familiar with.

Objectives: We evaluated the efficiency of noncontact mapping, a new mapping technique, for the catheter ablation of right ventricular outflow tract tachycardias., Study Design: The study included 13 symptomatic patients (4 males, 9 females; mean age 39+/-15 years) with a structurally normal heart, who had sustained ventricular tachycardia (VT) or nonsustained VT with ventricular premature beats (VPB), all arising from the right ventricular outflow tract. For noncontact mapping-guided (EnSite) ablation, first right ventricular geometry was reconstructed. Then, voltage maps of the right ventricle were obtained during sinus rhythm and tachycardia (or ectopic) beats. Index arrhythmia was induced in the form of sustained VT in three patients, and nonsustained VT or VPB in 10 patients. Radiofrequency was applied to endocardial foci of tachycardia beats using a standard, 4-mm ablation catheter., Results: The endocardial breakthrough sites of the beats were the posterior septum in seven patients, anterior septum in four patients, and posterior free wall in two patients. A mean of 25 (range 7 to 45) radiofrequency current deliveries were applied to the target sites. The mean procedure time was 190 minutes. Index arrhythmia was eliminated in 10 patients after the procedure. No serious complications occurred during or after the procedure., Conclusion: Our experience with radiofrequency ablation of right ventricular outflow tract tachycardias under noncontact mapping guidance shows that this procedure can be performed efficiently and safely in our country.

Right ventricular outflow tract tachycardias comprise a subgroup of idiopathic ventricular tachycardias that occur in the absence of structural heart disease. Twelve-lead surface electrocardiography shows a left bundle branch block morphology and an inferiorly-oriented frontal axis during tachycardia. Non-sustained nature of arrhythmia and structure of the outflow tract makes catheter ablation of focal arrhythmia origin difficult. Herein, we presented ablation of right ventricular outflow tract tachycardia in a 32-year-old male patient using a new, simplified technique, described by Saleem et al., for three-dimensional mapping of the outflow tract. The patient was admitted with tachycardia of left bundle branch block with inferior axis morphology. In this technique, a spiral multipolar catheter was positioned in the right ventricular outflow tract and served as a guide for mapping and ablation. The patient was asymptomatic in the first and third months of the procedure.

Background: The purpose of this meta‐analysis was to evaluate the impact of image integration technique on clinical and procedural outcomes in patients undergoing radiofrequency catheter ablation of atrial fibrillation with a three‐dimensional electroanatomic mapping system. Methods: Randomized controlled trials were identified through a systematic literature search of PubMed and CENTRAL databases from inception to April 2020. The primary outcome was arrhythmia recurrence during the follow‐up period. The secondary outcomes were the difference in total procedural time and fluoroscopy time. Results: Four studies with a total of 749 patients were included. The pooled result showed no statistically significant difference between the groups with respect to arrhythmia recurrence (RR, 0.75; 95% CI, 0.47‐1.21), fluoroscopy time (MD, −6 minutes; 95% CI, −23.4 to 11.3), and total procedural time (MD, 1.1 minutes; 95% CI, −31.8 to 34.1). Conclusion: Image integration to guide radiofrequency catheter ablation for patients with atrial fibrillation does not improve clinical and procedural outcomes. [ABSTRACT FROM AUTHOR]