Transient symptomatic ST-segment elevation following transseptal puncture for pulmonary vein isolation

Pulmonary vein isolation (PVI) become a standard procedure in atrial fibrillation (AF) treatment, proved to be more effective than antiarrhythmic medication alone. The procedure of PVI requires access to the left atrium, provided by the transseptal puncture (TSP), which carries potential risk of complication. We describe a case of transient, symptomatic ST-segment elevation in 57 year old male following TSP during PVI procedure. The symptoms resolved completely within next 5 minutes, however, concerning the potential risk factors we decided to discontinue the procedure and perform coronary angiography, which revealed no significant changes in the coronary arteries. Successful pulmonary vein isolation procedure was performed the next day without complications. We review the literature and discuss the possible causes of this phenomenon. The data suggest that transient ST-segment elevation is a rare incident associated with transseptal puncture, yet it should not impede continuation of the ablation procedure after thorough evaluation of the patient.