A Case of Acute Cardiac Tamponade Due to Aortic Rupture in Retrograde Aortic Radiofrequency Catheter Ablation of Left Ventricular Tachycardia

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The patient is a 71 years old woman with history of hypertension, diabetes and cerebral infarction. She was hospitalized for recurrent palpitation for 20 years, companied with low blood pressure, dizziness and amaurosis and efficacy of drugs is poor. ECG showed VT having two origins: outflow tract of right and left ventricle. UCG showed that ascending aorta 32 mm, LVEDD 49 mm, LVEF 57%. Radiofrequency catheter ablation of ventricular tachycardia was operated. Right ventricular pacing induced VT originated from LVOT. After five minutes of the radiofrequency catheter (deflectable 7 French 4 mm tip, temperature-controlled saline-irrigated catheter, IbI, ST JUDE) was inserted to the left ventricle retrogradely, the patient had dyspnea, chest ditress, sweating, with low blood pressure (68/45 mmHg) and heart rate (46 bpm). Diagnosis of cardiac tamponade was considered and pericardiopuncture was taken. But the hemodynamics could not keep steadily. So emergency pericardotomy was operated. During the pericardial exploration, injury of noncoronary sinus in root of ascending aorta was founded, the rupture was vertical with 3 mm length. Aortic rupture neoplasty was finished under extracorporeal circulation (4–0 Proline). The patient survived then. Aortic rupture in retrograde aortic radiofrequency catheter ablation has not been reported. The causes of aortic rupture may include aging, the main artery calcification and other factors.