Massive Air Embolism in the Left Atrial Appendage During Radiofrequency Atrial Fibrillation Ablation: A Case Report

Background: Air embolism is a complication of electrophysiological procedures, including atrial fibrillation (AF) ablation. Despite the benign course of air embolism in most patients, it can be a life-threatening event due to systemic air embolism to the coronary or brain circulation. Interruption of blood to vital organs may lead to serious damage.Case: A 77-year-old woman with a history of AF in the preceding 8 years was a candidate for AF ablation due to symptomatic persistent AF following the discontinuation of flecainide. Massive air embolism during catheter ablation developed in the left atrial appendage (LAA). Aspiration with a pigtail catheter through the trans-septal sheath was not successful, but the air was evacuated using the Judkins right catheter without any permanent complications. Conclusions: An operator must be au fait with all technical aspects of air embolism management. End-hole catheters may be more effective for the aspiration of aeroembolism in the LAA than multi-orifice pigtail catheters. (Iranian Heart Journal 2023; 24(2): 100-103)