An unusual complication of a pulmonary vein isolation.

A 59 year old patient with drug refractory paroxysmal atrial fibrillation (PAF) was referred for a pulmonary vein isolation (PVI). He complained of severe chest pain during the procedure. Subtle ST segment elevation was noted in the high lateral territory (I & aVL). He had no risk factors for coronary artery disease. The event occurred prior to any ablation within the left atrium (LA). He was haemodynamically stable (159/95 mmHg) and a pericardial effusion was excluded with transthoracic echocardiography. A coronary angiogram showed focal occlusion within a distal branch of the 1st diagonal. We discuss possible mechanisms for this unusual complication.