Acute myocardial infarction after radiofrequency catheter ablation of typical atrial flutter: histopathological findings and etiopathogenetic hypothesis

The right atrial inferior cavotricuspid isthmus represents the targeting site for radiofrequency (RF) current application during ablation treatment of typical atrial flutter. Despite the vicinity of the right coronary artery (RCA) to the RF application site and the long energy exposure needed to achieve electrophysiological success, reports about direct thermal damage of the coronary vessel during ablation of the cavotricuspid isthmus are rare and anecdotal. The present is the first case report describing the cardiac macroscopic and histological examination in a patient who died of cardiac rupture, as a complication of a myocardial infarction occurring after a standard procedure of RF ablation of typical atrial flutter. In consideration of the proximity we found between the RF energy-dependent tissue damage and the RCA, thermal-related damage of RCA during ablation of typical atrial flutter should always be considered as a potentially harmful risk of the procedure.