Postabaltive Pericarditis in Patient with a Prior History of Rheumatic Disease: a Case Report

A 60 year-old male with a previous (40 years ago) history of rheumatic carditis without valve involvement and 5 years history of paroxysmal atrial fibrillation underwent ablation (PV isolation with roof and mitral isthmus lines). The following day patient developed AF episode with severe mid-sternal chest pain with widespread concave ST elevation throughout most of the limb leads (I, II, III, aVL, aVF) and precordial leads (V2-6). Serum troponin I was 87.2 ng/ml with a creatinine concentration of 0.88 mg/dl and hemoglobin level of 15 g/dl. 2D transthoracic echocardiogram excluded wall motion abnormalities, or significant pericardial effusions. Recurrence of acute rheumatic fever was excluded based on revised Jones criteria. Careful analysis of ECG allowed us to recognize the ECG criteria of pericarditis and to avoid unnecessary emergent coronary angiography. Ultimately, the patient was diagnosed with pericarditis. After diagnosis, the patients presenting symptoms resolved with treatment including sotalol 160 mg per day, nonsteroidal anti-inflammatory agents. Conclusions: This is the first reported case study of post-cardiac ablation pericarditis in patient with prior history of rheumatic carditis.