Massive Air Embolism in the Left Atrial Appendage During Radiofrequency Atrial Fibrillation Ablation: A Case Report

Air embolism is a complication of electrophysiological procedures, including atrial fibrillation (AF) ablation. Despite the benign course of air embolism in most patients, it can be a life-threatening event due to systemic air embolism to the coronary or brain circulation. Interruption of blood to vital organs may lead to serious damage.

Case:

 A 77-year-old woman with a history of AF in the preceding 8 years was a candidate for AF ablation due to symptomatic persistent AF following the discontinuation of flecainide. Massive air embolism during catheter ablation developed in the left atrial appendage (LAA). Aspiration with a pigtail catheter through the trans-septal sheath was not successful, but the air was evacuated using the Judkins right catheter without any permanent complications.

An operator must be au fait with all technical aspects of air embolism management. End-hole catheters may be more effective for the aspiration of aeroembolism in the LAA than multi-orifice pigtail catheters.