Atrial Flutter Following Shockwave Intravascular Lithotripsy During Percutaneous Intervention of Left Anterior Descending Disease

Cardiovasc Revasc Med. 2022 Jul:40S:205-208. doi: 10.1016/j.carrev.2021.09.005. Epub 2021 Sep 28.

Abstract

A 72-year-old woman undergoing percutaneous intervention to a calcified proximal left anterior descending (LAD) coronary artery lesion using Shockwave Intravascular Lithotripsy (S-IVL) developed new atrial flutter. She then returned to sinus rhythm after treatment with amiodarone. S-IVL can cause cardiomyocyte depolarization. We hypothesize that pacing can occur during atrial repolarization, inducing supraventricular tachyarrhythmias and even triggering atrial macro re-entrant circuits. We recommend synchronizing shock wave delivery with R waves on the electrocardiogram to lower the risk of arrhythmias.

Keywords: Atrial flutter; Case report; Left anterior descending; Shockwave Intravascular Lithotripsy; Ventricular capture.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Arrhythmias, Cardiac / therapy
  • Atrial Flutter* / diagnosis
  • Atrial Flutter* / etiology
  • Atrial Flutter* / therapy
  • Coronary Vessels / pathology
  • Female
  • Humans
  • Lithotripsy* / adverse effects
  • Treatment Outcome
  • Vascular Calcification* / diagnostic imaging
  • Vascular Calcification* / etiology
  • Vascular Calcification* / therapy