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Uncommon presentation of postcardiac injury syndrome induced by radiofrequency catheter ablation for atrial fibrillation: Only pulmonary parenchymal inflammation
G Model
JCCASE-713; No. of Pages 4 Journal of Cardiology Cases xxx (2016) xxx–xxx
Contents lists available at ScienceDirect
Journal of Cardiology Cases journal homepage: www.elsevier.com/locate/jccase
Case Report
Uncommon presentation of postcardiac injury syndrome induced by radiofrequency catheter ablation for atrial fibrillation: Only pulmonary parenchymal inflammation Jie Han (MD)1, Yuanyuan Zhang (MS)1, Dongchen Zhou (MD), Biqi Zhang (MD), Tao Wu (MD), Liangrong Zheng (MD)* Department of Cardiovascular Sciences, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
A R T I C L E I N F O
A B S T R A C T
Article history: Received 21 October 2015 Received in revised form 15 February 2016 Accepted 9 March 2016
Postcardiac injury syndrome (PCIS) is characterized by the appearance of pericardial, pleural, or pulmonary parenchymal inflammation following a cardiac operation. The autoimmune disorder is characterized by eosinophilia, pleuritic chest pain, pleural, and pericardial effusion. It is a troublesome complication, which may prolong hospital stay and lead to severe and life-threatening conditions. Recently, its incidence appears to be declining, owing to modern immunomodulatory drug therapies. Here we report an uncommon case of PCIS, which occurred following a pulmonary vein isolation for atrial fibrillation. The patient suffered from pulmonary parenchymal inflammation but no pleuropericarditis after the operation. We describe with detailed clinical information, laboratory, and imaging tests, treatment processes, and a favorable prognosis in the content. This case illustrates that even after initially uneventful radiofrequency catheter ablation, careful, long-term follow-up is necessary to recognize the potential development of postcardiac injury syndrome. ß 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
Keywords: Postcardiac injury syndrome Radiofrequency catheter ablation Arrhythmia Complication
Introduction
Case report
The postcardiac injury syndrome (PCIS) is characterized by inflammation of the pericardium, pleura, and pulmonary parenchyma following myocardial infarction, cardiac surgery, blunt chest trauma, percutaneous left ventricle puncture, implantation of a pacemaker, and catheter ablation [1]. The literature contains information regarding the pericardium, pleural, and pulmonary manifestations of PCIS [2]. We report a rare case in which radiofrequency ablation of atrial fibrillation led to the development of pulmonary parenchymal inflammation but no pleuropericarditis.
A 68-year-old woman with paroxysmal atrial fibrillation that was not controlled by antiarrhythmic drugs was referred for electrophysiology evaluation and treatment (Figs. 1A and 2A). The ablation procedure consisted of a computed tomography (CT)-, CARTO-, and Lasso-guided circumferential pulmonary vein isolation. A three-dimensional anatomy of the left atrium and the pulmonary veins were created by CARTO Sound and ICE (Intra Cardiac Echocardiogram) catheter with an incorporated navigation sensor (SoundStarTM catheter, Biosense Webster, Diamond Bar, CA, USA) (Fig. 3). After the anatomical three-dimensional model of the left atrium was prepared, ablation was performed to encircle the right and left pulmonary veins in pairs, and no atrial fibrillation was induced after ablation. The radiofrequency generator was set to a temperature limit of 43 8C and energy of 30 W, and the total procedure time was 3 h. The trauma experienced by the heart during the ablation resulted in an inflammation of the myocardium.
* Corresponding author at: Department of Cardiovascular Sciences, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China. Tel.: +86 571 87236500; fax: +86 571 87236500. E-mail address: [email protected] (L. Zheng). 1 These authors contributed equally to this work.
http://dx.doi.org/10.1016/j.jccase.2016.03.002 1878-5409/ß 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Han J, et al. Uncommon presentation of postcardiac injury syndrome induced by radiofrequency catheter ablation for atrial fibrillation: Only pulmonary parenchymal inflammation. J Cardiol Cases (2016), http://dx.doi.org/10.1016/ j.jccase.2016.03.002
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JCCASE-713; No. of Pages 4 J. Han et al. / Journal of Cardiology Cases xxx (2016) xxx–xxx
2
Fig. 1.
Posteroanterior chest X-ray films before pulmonary vein isolation, during postcardiac injury syndrome, and after improvement. Enlarged cardiac silhouette (A, C) and ground-glass opacity (B) were present.
On the second day post ablation, the patient had a body temperature of 37.6 8C. The blood leukocyte count was 10.9 109/L (normal 4.0–10.0 109/L). C-reactive protein (CRP) level was slightly elevated to 11 mg/L (normal 0.0–8.0 mg/L). These values normalized in 4 days and the patient was discharged. Three weeks later, the patient developed cough and mild chest discomfort. On the day of readmission, she complained of increased shortness of breath. Physical examination revealed scattered rales and strengthened
Fig. 2.
respiratory voices but no heart murmur and S3 were heard on auscultation. Jugular venous pressure was not elevated. No peripheral edema was noted. The blood test showed that the leukocyte count was 6.6 109/L, along with an increased percentage of eosinophilic granulocytes of 7.8% (normal value 0.5–5.0%). Erythrocyte sedimentation rate (ESR, 51 mm/h, normal value 0–20 mm/h) and CRP concentration (32.1 mg/L, normal value 0–8 mg/L) were both elevated. The value of D-dimer, B-type
Representative images from the chest computed tomography (CT) and pulmonary vein angiography. (A) Preoperation: CT images showed that no lesions were found on bilateral lung fields. (B) Postoperation: CT images showed bilateral patchy areas of ground-glass opacity, which were distributed mainly in the inferior lobe of left lung close to heart. (C) Pulmonary vein angiography: No obvious pulmonary vein stenosis was detected and anatomic structures were in normal places. (D) Follow-up: CT scan performed 11 days later showed near-complete resolution of the lesions.
Please cite this article in press as: Han J, et al. Uncommon presentation of postcardiac injury syndrome induced by radiofrequency catheter ablation for atrial fibrillation: Only pulmonary parenchymal inflammation. J Cardiol Cases (2016), http://dx.doi.org/10.1016/ j.jccase.2016.03.002
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JCCASE-713; No. of Pages 4 J. Han et al. / Journal of Cardiology Cases xxx (2016) xxx–xxx
Fig. 3.
3
Electroanatomic mapping and ablation circle (red colored) using the CARTO Sound and ICE catheter. (A) Left lateral view. (B) Posteroanterior view. (C) Right lateral view.
natriuretic peptide, troponin I, and cardiac enzyme remained within the normal range. Tests for antinuclear antibody (ANA), antineutrophil cytoplasmic antibody (ANCA), anti-MPO, and anti-PR3 antibody in serum were negative. With the patient breathing room air, arterial blood gas values were as follows: pH, 7.43; PaCO2, 42.8 mmHg; PaO2, 68.1 mmHg. Echocardiogram showed an enlarged left atrium and no pericardial effusion was detected. Posteroanterior chest X-ray film revealed patchy areas of groundglass opacity (Fig. 1B). The CT of the chest showed the lung was scattered in high-density flake flocculent (Fig. 2B). No pericardial or pleural effusion was detected. CT angiography of pulmonary vein showed no obvious stenosis and anatomic structures were in normal places (Fig. 2C). Purified protein derivative (PPD) skin test was carried out to exclude tuberculosis. Antibiotics were used for diagnostic treatment. Nonetheless, no obvious improvement was observed under antibiotics therapy. On the basis of these laboratory and clinical findings, we diagnosed PCIS, which was related to the prior cardiac catheter ablation. She was subsequently treated with corticosteroid for half a month with great improvement of her symptoms and discharged (Fig. 1C). The eosinophilic granulocytes, CRP, and ESR levels normalized in 14 days. During a four-week follow-up period, the patient’s symptoms resolved and the pulmonary parenchymal inflammation had disappeared by the CT scan (Fig. 2D). Discussion PCIS was first described by Dressler [3]. It is characterized by fever, pericardial effusion, and pleural effusion. We report the case of a 68-year-old woman who developed a syndrome of pulmonary parenchymal inflammation without pleuropericarditis accompanied by a pronounced increase in eosinophilic granulocytes, ESR, and CRP levels following initial radiofrequency ablation of atrial fibrillation. The diagnosis of PCIS in a case following cardiac catheter intervention is difficult because patients no longer suffer from symptoms of the heart disease and general practitioners may undertake the follow-up role. Secondly, although PCIS has been clinically recognized for several decades, the lack of a confirmatory diagnostic test renders the diagnosis one of exclusion. Therefore, it would be important for clinicians to be aware of PCIS. In fact, patients with PCIS often receive unnecessary and inappropriate therapy for suspected congestive heart failure, pneumonia, or pulmonary emboli. Recently, diagnosis is based on clinical criteria – the occurrence within about a week after cardiac injury, and abnormal echocardiography and chest X-ray findings [4]. In our patient, the differential diagnosis including infectious,
thromboembolic, malignant diseases, and PCIS also should be considered. After extensive work has been done for excluding the other causes of the acute inflammatory syndrome, a diagnosis of PCIS without exudative pericardial and pleural effusions as a rare complication of radiofrequency ablation was made. The possibility that the symptoms might be categorized to another new syndrome was also likely and it was hoped that this paper might prompt other physicians to report on similar patients. A retrospective study of 35 patients with clearly defined PCIS has demonstrated that pleuropulmonary involvement is a common manifestation, since the chest X-ray film is abnormal in 94% of the patients [5]. Furthermore, investigators showed that the major clinical findings in the patients with PCIS were pulmonary parenchymal infiltrates (74%), pleurisy (91%), fever (66%), pericardial rub (63%), dyspnea (57%), roles (51%), pleural rub (46%), elevated ESR (96%), and leukocytosis (49%). Pleural effusion was present in 83%, and an enlarged cardiac silhouette in 49% [5]. In our case, the patient developed an uncommon presentation of pulmonary parenchymal inflammation without pleural and pericardiac effusion accompanied by a pronounced increase in eosinophilic granulocytes, ESR, and CRP levels. We first report that pulmonary manifestations of PCIS can be independent of pleuropericarditis. Currently, PCIS is considered as an inflammatory process that occurs in the setting of injury to the pericardium, epicardium, or myocardium [6]. It may follow cardiac surgery, myocardial infarction, trauma, intracardiac ablation, percutaneous coronary intervention, or implantation of a pacemaker or cardioverter– defibrillator [1]. In fact, the pathophysiology of PCIS is still unclear. An autoimmune mechanism with the involvement of both cellular and humoral immune responses is postulated [7]. The most accepted hypothesis involves autoantibodies that target antigens exposed after damage to cardiac tissue [8]. Accordingly, available data suggest a beneficial profile for nonsteroidal anti-inflammatory drugs and corticosteroid administration [9]. In our case, short-term treatment with corticosteroids eventually resulted in complete clinical and imaging recovery of the pulmonary parenchymal inflammation and a normalization of inflammatory markers. Conflict of interest None declared. Acknowledgments This work was supported by the National Natural Science Foundation of China (Project Nos. 81200191 and 81400277).
Please cite this article in press as: Han J, et al. Uncommon presentation of postcardiac injury syndrome induced by radiofrequency catheter ablation for atrial fibrillation: Only pulmonary parenchymal inflammation. J Cardiol Cases (2016), http://dx.doi.org/10.1016/ j.jccase.2016.03.002
G Model
JCCASE-713; No. of Pages 4 J. Han et al. / Journal of Cardiology Cases xxx (2016) xxx–xxx
4
References [1] Sedaghat-Hamedani F, Zitron E, Kayvanpour E, Lorenz HM, Katus HA, Meder B. Post cardiac injury syndrome after initially uncomplicated CRT-D implantation: a case report and a systematic review. Clin Res Cardiol 2014;103:781–9. [2] Tralha˜o A, Cavaco D, Trabulo M, Ferreira AM. The return of a disappearing entity: Dressler’s syndrome after transvenous pacemaker implantation. BMJ Case Rep 2014. http://dx.doi.org/10.1136/bcr-2013-203401. [3] Dressler W. A post-myocardial-infarction syndrome: preliminary report of a complication resembling idiopathic, recurrent, benign pericarditis. J Am Med Assoc 1956;160:1379–83. [4] Imazio M, Brucato A, Ferrazzi P, Spodick DH, Adler Y. Postpericardiotomy syndrome: a proposal for diagnostic criteria. J Cardiovasc Med (Hagerstown) 2013;14:351–3.
[5] Stelzner TJ, King JTE, Antony VB, Sahn SA. The pleuropulmonary manifestations of the postcardiac injury syndrome. Chest 1983;84:383–7. [6] Imazio M, Brucato A, Rovere ME, Gandino A, Cemin R, Ferrua S, Maestroni S, Barosi A, Simon C, Ferrazzi P, Belli R, Trinchero R, Spodick D, Adler Y. Contemporary features, risk factors, and prognosis of the post-pericardiotomy syndrome. Am J Cardiol 2011;108:1183–7. [7] Kocazeybek B, Erentu¨rk S, Caly´k MK, Babacan F. An immunological approach to postpericardiotomy syndrome occurrence and its relation with autoimmunity. Acta Chir Belg 1998;98:203–6. [8] Erlich JF, Paz Z. Postpericardial injury syndrome: an autoimmune phenomenon. Clin Rev Allergy Immunol 2010;38:156–8. [9] Imazio M, Brucato A, Markel G, Cemin R, Trinchero R, Spodick DH, Adler Y. Metaanalysis of randomized trials focusing on prevention of the postpericardiotomy syndrome. Am J Cardiol 2011;108:575–9.
Please cite this article in press as: Han J, et al. Uncommon presentation of postcardiac injury syndrome induced by radiofrequency catheter ablation for atrial fibrillation: Only pulmonary parenchymal inflammation. J Cardiol Cases (2016), http://dx.doi.org/10.1016/ j.jccase.2016.03.002
JCCASE-713; No. of Pages 4 Journal of Cardiology Cases xxx (2016) xxx–xxx
Contents lists available at ScienceDirect
Journal of Cardiology Cases journal homepage: www.elsevier.com/locate/jccase
Case Report
Uncommon presentation of postcardiac injury syndrome induced by radiofrequency catheter ablation for atrial fibrillation: Only pulmonary parenchymal inflammation Jie Han (MD)1, Yuanyuan Zhang (MS)1, Dongchen Zhou (MD), Biqi Zhang (MD), Tao Wu (MD), Liangrong Zheng (MD)* Department of Cardiovascular Sciences, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
A R T I C L E I N F O
A B S T R A C T
Article history: Received 21 October 2015 Received in revised form 15 February 2016 Accepted 9 March 2016
Postcardiac injury syndrome (PCIS) is characterized by the appearance of pericardial, pleural, or pulmonary parenchymal inflammation following a cardiac operation. The autoimmune disorder is characterized by eosinophilia, pleuritic chest pain, pleural, and pericardial effusion. It is a troublesome complication, which may prolong hospital stay and lead to severe and life-threatening conditions. Recently, its incidence appears to be declining, owing to modern immunomodulatory drug therapies. Here we report an uncommon case of PCIS, which occurred following a pulmonary vein isolation for atrial fibrillation. The patient suffered from pulmonary parenchymal inflammation but no pleuropericarditis after the operation. We describe with detailed clinical information, laboratory, and imaging tests, treatment processes, and a favorable prognosis in the content. This case illustrates that even after initially uneventful radiofrequency catheter ablation, careful, long-term follow-up is necessary to recognize the potential development of postcardiac injury syndrome.
Keywords: Postcardiac injury syndrome Radiofrequency catheter ablation Arrhythmia Complication
Introduction
Case report
The postcardiac injury syndrome (PCIS) is characterized by inflammation of the pericardium, pleura, and pulmonary parenchyma following myocardial infarction, cardiac surgery, blunt chest trauma, percutaneous left ventricle puncture, implantation of a pacemaker, and catheter ablation [1]. The literature contains information regarding the pericardium, pleural, and pulmonary manifestations of PCIS [2]. We report a rare case in which radiofrequency ablation of atrial fibrillation led to the development of pulmonary parenchymal inflammation but no pleuropericarditis.
A 68-year-old woman with paroxysmal atrial fibrillation that was not controlled by antiarrhythmic drugs was referred for electrophysiology evaluation and treatment (Figs. 1A and 2A). The ablation procedure consisted of a computed tomography (CT)-, CARTO-, and Lasso-guided circumferential pulmonary vein isolation. A three-dimensional anatomy of the left atrium and the pulmonary veins were created by CARTO Sound and ICE (Intra Cardiac Echocardiogram) catheter with an incorporated navigation sensor (SoundStarTM catheter, Biosense Webster, Diamond Bar, CA, USA) (Fig. 3). After the anatomical three-dimensional model of the left atrium was prepared, ablation was performed to encircle the right and left pulmonary veins in pairs, and no atrial fibrillation was induced after ablation. The radiofrequency generator was set to a temperature limit of 43 8C and energy of 30 W, and the total procedure time was 3 h. The trauma experienced by the heart during the ablation resulted in an inflammation of the myocardium.
* Corresponding author at: Department of Cardiovascular Sciences, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China. Tel.: +86 571 87236500; fax: +86 571 87236500. E-mail address: [email protected] (L. Zheng). 1 These authors contributed equally to this work.
http://dx.doi.org/10.1016/j.jccase.2016.03.002 1878-5409/ß 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Han J, et al. Uncommon presentation of postcardiac injury syndrome induced by radiofrequency catheter ablation for atrial fibrillation: Only pulmonary parenchymal inflammation. J Cardiol Cases (2016), http://dx.doi.org/10.1016/ j.jccase.2016.03.002
G Model
JCCASE-713; No. of Pages 4 J. Han et al. / Journal of Cardiology Cases xxx (2016) xxx–xxx
2
Fig. 1.
Posteroanterior chest X-ray films before pulmonary vein isolation, during postcardiac injury syndrome, and after improvement. Enlarged cardiac silhouette (A, C) and ground-glass opacity (B) were present.
On the second day post ablation, the patient had a body temperature of 37.6 8C. The blood leukocyte count was 10.9 109/L (normal 4.0–10.0 109/L). C-reactive protein (CRP) level was slightly elevated to 11 mg/L (normal 0.0–8.0 mg/L). These values normalized in 4 days and the patient was discharged. Three weeks later, the patient developed cough and mild chest discomfort. On the day of readmission, she complained of increased shortness of breath. Physical examination revealed scattered rales and strengthened
Fig. 2.
respiratory voices but no heart murmur and S3 were heard on auscultation. Jugular venous pressure was not elevated. No peripheral edema was noted. The blood test showed that the leukocyte count was 6.6 109/L, along with an increased percentage of eosinophilic granulocytes of 7.8% (normal value 0.5–5.0%). Erythrocyte sedimentation rate (ESR, 51 mm/h, normal value 0–20 mm/h) and CRP concentration (32.1 mg/L, normal value 0–8 mg/L) were both elevated. The value of D-dimer, B-type
Representative images from the chest computed tomography (CT) and pulmonary vein angiography. (A) Preoperation: CT images showed that no lesions were found on bilateral lung fields. (B) Postoperation: CT images showed bilateral patchy areas of ground-glass opacity, which were distributed mainly in the inferior lobe of left lung close to heart. (C) Pulmonary vein angiography: No obvious pulmonary vein stenosis was detected and anatomic structures were in normal places. (D) Follow-up: CT scan performed 11 days later showed near-complete resolution of the lesions.
Please cite this article in press as: Han J, et al. Uncommon presentation of postcardiac injury syndrome induced by radiofrequency catheter ablation for atrial fibrillation: Only pulmonary parenchymal inflammation. J Cardiol Cases (2016), http://dx.doi.org/10.1016/ j.jccase.2016.03.002
G Model
JCCASE-713; No. of Pages 4 J. Han et al. / Journal of Cardiology Cases xxx (2016) xxx–xxx
Fig. 3.
3
Electroanatomic mapping and ablation circle (red colored) using the CARTO Sound and ICE catheter. (A) Left lateral view. (B) Posteroanterior view. (C) Right lateral view.
natriuretic peptide, troponin I, and cardiac enzyme remained within the normal range. Tests for antinuclear antibody (ANA), antineutrophil cytoplasmic antibody (ANCA), anti-MPO, and anti-PR3 antibody in serum were negative. With the patient breathing room air, arterial blood gas values were as follows: pH, 7.43; PaCO2, 42.8 mmHg; PaO2, 68.1 mmHg. Echocardiogram showed an enlarged left atrium and no pericardial effusion was detected. Posteroanterior chest X-ray film revealed patchy areas of groundglass opacity (Fig. 1B). The CT of the chest showed the lung was scattered in high-density flake flocculent (Fig. 2B). No pericardial or pleural effusion was detected. CT angiography of pulmonary vein showed no obvious stenosis and anatomic structures were in normal places (Fig. 2C). Purified protein derivative (PPD) skin test was carried out to exclude tuberculosis. Antibiotics were used for diagnostic treatment. Nonetheless, no obvious improvement was observed under antibiotics therapy. On the basis of these laboratory and clinical findings, we diagnosed PCIS, which was related to the prior cardiac catheter ablation. She was subsequently treated with corticosteroid for half a month with great improvement of her symptoms and discharged (Fig. 1C). The eosinophilic granulocytes, CRP, and ESR levels normalized in 14 days. During a four-week follow-up period, the patient’s symptoms resolved and the pulmonary parenchymal inflammation had disappeared by the CT scan (Fig. 2D). Discussion PCIS was first described by Dressler [3]. It is characterized by fever, pericardial effusion, and pleural effusion. We report the case of a 68-year-old woman who developed a syndrome of pulmonary parenchymal inflammation without pleuropericarditis accompanied by a pronounced increase in eosinophilic granulocytes, ESR, and CRP levels following initial radiofrequency ablation of atrial fibrillation. The diagnosis of PCIS in a case following cardiac catheter intervention is difficult because patients no longer suffer from symptoms of the heart disease and general practitioners may undertake the follow-up role. Secondly, although PCIS has been clinically recognized for several decades, the lack of a confirmatory diagnostic test renders the diagnosis one of exclusion. Therefore, it would be important for clinicians to be aware of PCIS. In fact, patients with PCIS often receive unnecessary and inappropriate therapy for suspected congestive heart failure, pneumonia, or pulmonary emboli. Recently, diagnosis is based on clinical criteria – the occurrence within about a week after cardiac injury, and abnormal echocardiography and chest X-ray findings [4]. In our patient, the differential diagnosis including infectious,
thromboembolic, malignant diseases, and PCIS also should be considered. After extensive work has been done for excluding the other causes of the acute inflammatory syndrome, a diagnosis of PCIS without exudative pericardial and pleural effusions as a rare complication of radiofrequency ablation was made. The possibility that the symptoms might be categorized to another new syndrome was also likely and it was hoped that this paper might prompt other physicians to report on similar patients. A retrospective study of 35 patients with clearly defined PCIS has demonstrated that pleuropulmonary involvement is a common manifestation, since the chest X-ray film is abnormal in 94% of the patients [5]. Furthermore, investigators showed that the major clinical findings in the patients with PCIS were pulmonary parenchymal infiltrates (74%), pleurisy (91%), fever (66%), pericardial rub (63%), dyspnea (57%), roles (51%), pleural rub (46%), elevated ESR (96%), and leukocytosis (49%). Pleural effusion was present in 83%, and an enlarged cardiac silhouette in 49% [5]. In our case, the patient developed an uncommon presentation of pulmonary parenchymal inflammation without pleural and pericardiac effusion accompanied by a pronounced increase in eosinophilic granulocytes, ESR, and CRP levels. We first report that pulmonary manifestations of PCIS can be independent of pleuropericarditis. Currently, PCIS is considered as an inflammatory process that occurs in the setting of injury to the pericardium, epicardium, or myocardium [6]. It may follow cardiac surgery, myocardial infarction, trauma, intracardiac ablation, percutaneous coronary intervention, or implantation of a pacemaker or cardioverter– defibrillator [1]. In fact, the pathophysiology of PCIS is still unclear. An autoimmune mechanism with the involvement of both cellular and humoral immune responses is postulated [7]. The most accepted hypothesis involves autoantibodies that target antigens exposed after damage to cardiac tissue [8]. Accordingly, available data suggest a beneficial profile for nonsteroidal anti-inflammatory drugs and corticosteroid administration [9]. In our case, short-term treatment with corticosteroids eventually resulted in complete clinical and imaging recovery of the pulmonary parenchymal inflammation and a normalization of inflammatory markers. Conflict of interest None declared. Acknowledgments This work was supported by the National Natural Science Foundation of China (Project Nos. 81200191 and 81400277).
Please cite this article in press as: Han J, et al. Uncommon presentation of postcardiac injury syndrome induced by radiofrequency catheter ablation for atrial fibrillation: Only pulmonary parenchymal inflammation. J Cardiol Cases (2016), http://dx.doi.org/10.1016/ j.jccase.2016.03.002
G Model
JCCASE-713; No. of Pages 4 J. Han et al. / Journal of Cardiology Cases xxx (2016) xxx–xxx
4
References [1] Sedaghat-Hamedani F, Zitron E, Kayvanpour E, Lorenz HM, Katus HA, Meder B. Post cardiac injury syndrome after initially uncomplicated CRT-D implantation: a case report and a systematic review. Clin Res Cardiol 2014;103:781–9. [2] Tralha˜o A, Cavaco D, Trabulo M, Ferreira AM. The return of a disappearing entity: Dressler’s syndrome after transvenous pacemaker implantation. BMJ Case Rep 2014. http://dx.doi.org/10.1136/bcr-2013-203401. [3] Dressler W. A post-myocardial-infarction syndrome: preliminary report of a complication resembling idiopathic, recurrent, benign pericarditis. J Am Med Assoc 1956;160:1379–83. [4] Imazio M, Brucato A, Ferrazzi P, Spodick DH, Adler Y. Postpericardiotomy syndrome: a proposal for diagnostic criteria. J Cardiovasc Med (Hagerstown) 2013;14:351–3.
[5] Stelzner TJ, King JTE, Antony VB, Sahn SA. The pleuropulmonary manifestations of the postcardiac injury syndrome. Chest 1983;84:383–7. [6] Imazio M, Brucato A, Rovere ME, Gandino A, Cemin R, Ferrua S, Maestroni S, Barosi A, Simon C, Ferrazzi P, Belli R, Trinchero R, Spodick D, Adler Y. Contemporary features, risk factors, and prognosis of the post-pericardiotomy syndrome. Am J Cardiol 2011;108:1183–7. [7] Kocazeybek B, Erentu¨rk S, Caly´k MK, Babacan F. An immunological approach to postpericardiotomy syndrome occurrence and its relation with autoimmunity. Acta Chir Belg 1998;98:203–6. [8] Erlich JF, Paz Z. Postpericardial injury syndrome: an autoimmune phenomenon. Clin Rev Allergy Immunol 2010;38:156–8. [9] Imazio M, Brucato A, Markel G, Cemin R, Trinchero R, Spodick DH, Adler Y. Metaanalysis of randomized trials focusing on prevention of the postpericardiotomy syndrome. Am J Cardiol 2011;108:575–9.
Please cite this article in press as: Han J, et al. Uncommon presentation of postcardiac injury syndrome induced by radiofrequency catheter ablation for atrial fibrillation: Only pulmonary parenchymal inflammation. J Cardiol Cases (2016), http://dx.doi.org/10.1016/ j.jccase.2016.03.002