Mitral Valve Injury After Radiofrequency Ablation for Wolff-Parkinson-White Syndrome

A 39-year-old athletic female with symptomatic Wolff-Parkinson-White syndrome underwent an electrophysiological study and subsequent ablation of orthodromic reentrant tachycardias using left lateral, posterolateral, and posteroseptal accessory pathways. Ablation was performed with 7F medium- and large-curl Safire catheters using the retrograde aortic approach. Eighteen radiofrequency lesions were delivered at the mitral valve annulus (50 W, 60°, 10–60 seconds), and 8 were delivered in the coronary sinus, with weak persistence of antegrade conduction through the posteroseptal pathway. Two weeks later, she presented to the emergency room with a new episode of supraventricular tachycardia, She had been having dyspnea since the ablation procedure. A transthoracic echocardiogram revealed severe mitral regurgitation with a regurgitant volume of 66 ml and estimated regurgitant orifice of 39 mm2 (Figure [C, F, and G]); the left atrium was enlarged with a volume index of 36 ml/m2. Transesophageal echocardiogram revealed a ruptured chord to the anterior leaflet adjacent to the posteromedial commissure (Figure [E]). Given the symptoms and severity of the mitral valve regurgitation, the decision …