Coronary air embolism complicating transseptal radiofrequency ablation of left free-wall accessory pathways.

Radiofrequency catheter ablation is an important new technique for curing patients with accessory pathway-mediated tachycardia. Ablation of left free-wall accessory pathways may be accomplished either by a retrograde, transarterial approach or via a transseptal approach using a long vascular sheath. We describe air embolization into the coronary artery as a complication of the transseptal approach, which was temporally associated with catheter exchange. While there were no permanent adverse sequelae, this report emphasizes the need for scrupulous attention to the possible insinuation of air during procedures involving long vascular sheaths across the atrial septum. To prevent air embolism, we recommend slow removal of the ablation catheter along with continuous flushing with heparinized saline during exchanges.