Work

The Electrophysiologist's Worst-Case Scenario

Year: 2026

Type: article

Abstract: A 49-year-old woman undergoing pulsed-field ablation for symptomatic atrial fibrillation experienced a near-miss aortic entry during transseptal access. Despite apparently adequate fluoroscopic positioning, subtly rotated septal anatomy masked an anterior trajectory. Contrast injection through an NRG radiofrequency needle unexpectedly delineated the external aortic root before sheath advancement. Immediate transesophageal echocardiography and subsequent computed tomography confirmed the absence of structural injury. The ablation was safely completed 2 days later. This case illustrates how challenging septal orientation can limit the reliability of fluoroscopic cues, and it highlights the complementary safety value of contrast-capable radiofrequency needles and adjunctive imaging.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2026.106926

Authors: Jacopo Costantino, Massimiliano Campoli, Barbara Romani, Lorenzo Maria Zuccaro, Daniele Porcelli

Institutions: University of Padua, Fatebenefratelli Hospital, Ospedale San Pietro Fatebenefratelli, Sapienza University of Rome

Language: English

Topic: Cardiac Arrhythmias and Treatments

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850