ST‐Elevation Myocardial Infarction Secondary to Intracoronary Air Embolism During Atrial Fibrillation Ablation: Case Report and Successful Management

TL;DR

A woman undergoing heart ablation developed a dangerous air embolism, which was successfully treated with adenosine, highlighting the need for careful monitoring during such procedures.

Contribution

This case report presents a rare complication of intracoronary air embolism during atrial fibrillation ablation and its successful management.

Findings

Real-time ST-segment elevation was observed during the ablation procedure.

Intracoronary adenosine restored coronary flow to TIMI 3 levels.

The patient developed biventricular cardiogenic shock requiring coronary care unit management.

Abstract

We present the case of a 47‐year‐old woman with persistent atrial fibrillation who underwent catheter ablation. During the procedure, real‐time ST‐segment elevation was observed on surface ECG. An emergency coronary angiography revealed an air embolism in the proximal segment of the left anterior descending (LAD) coronary artery. Intracoronary adenosine was administered, successfully restoring coronary flow (TIMI 3). The procedure was aborted, and the patient was subsequently managed in the coronary care unit due to biventricular cardiogenic shock secondary to myocardial stunning. This case highlights the importance of strict hemodynamic monitoring and prompt recognition and response to uncommon complications during catheter ablation procedures.

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