Iatrogenic acute coronary occlusion during epicardial ventricular tachycardia ablation: when intravascular imaging guides the management-a case report.

Background: Ventricular epicardial mapping and ablations pose a significant risk of multiple complications, such as iatrogenic injuries to the coronary arteries.

Case summary: We report a case of acute coronary occlusion during epicardial ventricular tachycardia ablation, detected by ST-segment elevation during the procedure. The multidisciplinary consultation, combined with the use of multimodality imaging, led to the final diagnosis of extrinsic compression caused by a parietal haematoma. This diagnosis guided the decision for conservative management and allowed the team to avoid stent implantation.

Discussion: This case report highlights how multidisciplinary consultation and intravascular ultrasound guidance could lead to a conservative balloon angioplasty treatment strategy, avoiding stent implantation.