Hepatic vein injury after atrial tachycardia ablation: a rare cause of hemoperitoneum: case report

Catheter ablation for atrial arrhythmias is a common procedure with the possibility of causing complications, typically involving vascular access sites or cardiac tamponade. However, hepatic haemorrhage as a complication of cardiac catheter ablation is extremely rare. We present a case of life-threatening intra-abdominal bleeding originating from a hepatic vein following a catheter ablation for atrial tachycardia.

A 67-year-old man with a history of mitral valve repair and multiple ablation procedures for atrial fibrillation, atrial flutter, and macro-reentrant atrial tachycardia (MRAT) underwent a redo catheter ablation for MRAT. After the procedure, he developed right flank pain, hypotension, and a drop in haemoglobin. Imaging revealed extensive hemoperitoneum, originating near the right hepatic vein. Angiography of the visceral arteries was performed on which no major source of bleeding was identified. Because of persisting haemodynamic instability, the patient underwent emergency laparoscopy during which a capsular venous bleeding on the caudal liver surface was identified, likely caused by transient guidewire passage and injury in the hepatic veins. The bleeding was cauterized, and abdominal lavage was performed to clear the hemoperitoneum. He was transferred to the ICU for vasopressor support. Anticoagulation was restarted 1 week later, and the patient was discharged in stable condition.

This case highlights a rare but serious complication of catheter ablation. Prompt recognition of intra-abdominal haemorrhage and a multidisciplinary approach involving cardiology, radiology, and surgery were crucial for a successful outcome. Operators should remain vigilant for atypical bleeding complications in ablation procedures and be prepared to initiate rapid intervention.