Right Coronary Artery to Left Ventricular Fistula Complicated by Symptomatic Arrhythmia

TL;DR

A 32-year-old man with a rare heart condition involving an abnormal blood vessel connection experienced arrhythmias and was successfully treated with catheter-based procedures.

Contribution

This case highlights the rare association of symptomatic arrhythmia with a right coronary artery to left ventricular fistula.

Findings

The patient had a large coronary cameral fistula from the right posterior descending artery to the left ventricle.

Catheter-based occlusion and ablation resolved the arrhythmia without evidence of cardiomyopathy or heart scarring.

The case emphasizes the need for a multidisciplinary approach in managing such rare cardiac anomalies.

Abstract

Coronary cameral fistulas (CCFs) are rare and are characterized by an abnormal connection between a coronary artery and any of the four chambers of the heart. Most cases of CCFs are asymptomatic. The most common presentation in symptomatic patients includes chest pain or heart failure; however, arrhythmias are rarely associated. We report the case of a 32-year-old male previously unknown to have any medical illnesses. He presented to the clinic with complaints of frequent palpitations, necessitating recurrent admissions. His electrocardiograms revealed regular wide complex tachycardia with a right bundle branch block pattern, suggestive of fascicular ventricular tachycardia. During hospitalization, an elective coronary angiography showed a large CCF originating from the right posterior descending coronary artery and draining into the left ventricle. Moreover, cardiac magnetic resonance imaging did not show any scar or evidence of cardiomyopathies. The patient underwent a successful catheter-based right coronary artery to left ventricular fistula occlusion with coils. In addition, the patient underwent a complex electrophysiological study with three-dimensional mapping and ablation. The presented case underscores the rarity and complexity of such clinical presentations. It also highlights the importance of a multidisciplinary approach in addressing this unique cardiac anomaly.

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