Akutes Koronarsyndrom nach Katheterablation von Vorhofflattern

A 52-year old engineer with recurrent tachycardia and palpitations in the history, appeared with a sustained tachycardia (heart rate 137 beats per minute) in an emergency room. A narrow QRS complex tachycardia (QRS width <0.12 s) with regular RR-intervals and negative flutter waves in leads II, III and aVF was visible in the 12-lead surface electrocardiogram and allowed the diagnosis of "common type" atrial flutter (Aflut). After delivery of a 200 J biphasic DC-shock, the tachycardia stopped immediately and sinus rhythm with normal rate was present. Due to several risk factors, coronary angiography with normal findings was performed prior to catheterization (CA) of Aflut. Radiofrequency (RF) CA was performed in the same session without any problems and 18 RF energies between the right inferior (tricuspid valve) and the vena cava inferior leading to a bidirectional block. During a 30 min waiting period, the patient suffered from angina pectoris at rest, responsibly from nitroglycerin. The immediately performed coronary angiography revealed a subtotal stenosis of the right coronary artery (RCA) close to the crux cordis. Percutaneous coronary intervention with angioplasty and T-stenting was performed with an excellent result. During the mean follow-up of 6 months, the patient is doing fine without any signs of CAD or Aflut.