Left atrial intramural haematoma-a rare complication following radiofrequency ablation of atrial fibrillation: a case report.

Background: Ablation is increasingly used to treat atrial fibrillation (AF), and recognizing potential complications is essential. We present a case of left atrial intramural haematoma after radiofrequency ablation (RFA), successfully managed with a conservative approach. Case summary: A 39-year-old man underwent pulmonary vein isolation (PVI). During RFA with a contact-force catheter, the areas close to the left superior pulmonary vein, including the left atrial appendage, roof, and posterior wall, showed absent electrical signal. Left atrial scarring was suspected. PVI was completed. On the following day, the patient had chest pain. Transthoracic echocardiography revealed pericardial effusion and a large left atrial mass. Computed tomography confirmed a left atrial intramural haematoma extending into the left atrial cavity. Anticoagulation was discontinued. The patient developed worsening chest tightness on postoperative day 2 due to increasing of pericardial effusion. Pericardiocentesis was performed to relieve symptoms, and 400 mL of bloody fluid was drained. The effusion did not progress further. The drain was removed three days later, and the haematoma was managed conservatively with a favourable outcome. Discussion: Left atrial intramural haematoma can occur following left atrial RFA. Diagnosis relies on multimodality imaging, including echocardiogram and computed tomography. Furthermore, intra-procedural mapping abnormalities, such as a large low-voltage area, may indicate an evolving complication. Early recognition of this rare but potentially life-threatening complication can guide prompt and appropriate management. In stable patients, close clinical and imaging follow-up is appropriate, as shown in our case. In severe cases with haemodynamic compromise, urgent surgical intervention may be required.