Life-threatening coronary sinus thrombosis following catheter ablation: case report and review of literature

Coronary sinus thrombosis is an extremely rare clinical syndrome with a high fatality rate. It is associated with procedures in the right heart, including insertion of pacemaker wires, Swan-Ganz catheters, and central venous lines. Recognition is often late, and treatment options are not well characterized. We present a case of acute coronary sinus thrombosis and occlusion associated with electrophysiologic ablation for supraventricular tachycardia in an 11-year-old boy. He developed chest pain, ST elevation, a large pericardial effusion, and cardiogenic shock. Emergent cardiac catheterization and percutaneous intervention with rheolytic aspiration thrombectomy resulted in a dramatic recovery. With the advent of new technologies and procedures involving the right heart and coronary sinus, an appreciation of this potentially lethal complication and possible treatment strategies is important.