Bronchial Arteriovenous Malformation Detection Prior to Catheter Ablation for Paroxysmal Atrial Flutter and Fibrillation: A Case Report.

Abstract

BACKGROUND Catheter ablation for paroxysmal atrial flutter (PAFL) and atrial fibrillation (PAF) is a first-line treatment to maintain sinus rhythm. However, routine preprocedural imaging is not standardized, despite a high prevalence of incidental findings that may influence procedural planning. This report describes a case of a bronchial arteriovenous malformation (BAVM) detected on multidetector computed tomography prior to ablation in a patient with PAFL and PAF. CASE REPORT A 69-year-old woman who predominantly experienced episodes of PAFL, with occasional PAF, underwent pre-ablation multidetector computed tomography. Imaging demonstrated a serpiginous bronchial artery draining into the right pulmonary artery, with 2 aneurysms (approximately 1 cm proximal to the aortic origin and 4 cm proximal to the drainage site) in close proximity to the right pulmonary veins. Hemodynamic evaluation confirmed a non-significant left-to-right shunt, and a conservative approach was selected. Because of perioperative concerns about the BAVM's location, the procedural plan was modified; rather than a combined procedure of pulmonary vein isolation with right isthmus ablation, only a typical PAFL ablation was performed. The patient had an uneventful post-procedural course, without arrhythmic recurrence or BAVM-related complications at 6 months. Annual follow-ups with contrast-enhanced computed tomography angiography were scheduled after joint cardiology and radiology consultation. CONCLUSIONS This case highlights the importance of systematic preprocedural imaging in PAF and PAFL ablation to detect unexpected intra- or extracardiac findings, such as a BAVM, that may affect procedural strategy and require a multidisciplinary approach.