Guide Wire Stimulation During Catheter Ablation for Atrial Fibrillation-Induced Cardiac Arrest in a Patient With Preexisting Left Bundle Branch Block: A Case Report

Right bundle branch block can occasionally occur when a guide wire or catheter is inserted into the heart. An 83-year-old woman with preexisting left bundle branch block (LBBB) was diagnosed with paroxysmal atrial fibrillation (PAF) and severe mitral regurgitation (MR). The patient was started on amiodarone (100 mg/day) and bisoprolol (1.25 mg/day). The patient underwent catheter ablation for PAF after a percutaneous edge-to-edge mitral valve repair for MR. During the ablation procedure, performed under a sedation with dexmedetomidine, guide wire stimulation led to a paroxysmal atrioventricular block (AVB), resulting in cardiac arrest. Cardiopulmonary resuscitation was performed for 2 min, one ampule of intravenous adrenaline was administered, and a return of spontaneous circulation was obtained. The patient subsequently developed takotsubo cardiomyopathy due to the administration of catecholamines. Three months later, re-ablation was performed safely under fluoroscopic guidance and the use of noninvasive transcutaneous pacemaker. Fluoroscopic guide wire manipulation and the use of noninvasive transcutaneous pacemaker are essential for patients with LBBB to prevent paroxysmal AVB and cardiac arrest.