Retrograde PVC ablation can cause rare but serious iatrogenic left main coronary artery dissectionRare heart complication occurs during procedure to treat heart rhythm

Frontiers in Medicine Published September 15, 2026 DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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Key Takeaway

Note that retrograde PVC ablation can cause rare iatrogenic LMCA dissection requiring emergent CABG.

This case report describes a 60-year-old man with symptomatic, medication-refractory monomorphic PVCs and a 17.4% burden with nonsustained ventricular tachycardia. The patient underwent elective PVC ablation via retrograde aortic access. During the procedure, an iatrogenic LMCA dissection occurred, resulting in occlusion of the proximal LAD and near-occlusive involvement of the proximal ramus intermedius.

The patient experienced hemodynamic instability and ST-segment elevation following the dissection. Emergency coronary angiography and subsequent coronary artery bypass grafting (CABG) were performed. At a 3-month follow-up, the patient's ejection fraction was reduced to 25% to 30%.

The authors note that while LMCA ostial injury is a rare complication of retrograde PVC ablation, it requires rapid recognition of ST-segment elevation and early Heart Team involvement. Intravascular ultrasound (IVUS) was identified as a crucial tool for defining the extent of the dissection. The case highlights the necessity of CABG for definitive revascularization in cases of ostial or bifurcation LMCA dissection involving hemodynamic compromise and unfavorable anatomy. Due to the single case report nature, the generalizability of these findings is limited.

Imagine a patient struggling with a persistent, irregular heartbeat that medication cannot fix. For this 60-year-old man, doctors attempted a procedure called ablation to stop the extra heartbeats. While the goal was to stabilize his heart rhythm, the procedure led to a rare and serious complication involving a major artery.

During the procedure, a tear occurred in the left main coronary artery. This is a critical artery that supplies blood to the heart muscle. The injury caused the patient's heart function to drop significantly within three months. This case highlights how even targeted procedures can sometimes lead to unexpected and serious complications.

Because this was a single case, we cannot say how often this happens. However, it shows why it is vital for medical teams to recognize signs of trouble immediately. When things go wrong, having a specialized heart team and advanced imaging can help doctors move quickly to perform life-saving surgery.

What this means for you:

A rare artery tear during a heart rhythm procedure shows the importance of rapid response and expert teamwork.

Common questions

What happened during the heart procedure?

During a procedure to treat a heart rhythm issue called premature ventricular contractions, a man experienced a rare tear in his left main coronary artery. This artery is a major vessel. The injury caused his heart's pumping ability to drop to 25% to 30% after three months. This was a serious complication that required emergency surgery.

How common is this complication?

This specific complication is considered rare. Because this report describes only one individual case, it is difficult to know exactly how often it happens. However, it serves as a warning for doctors to watch for specific signs of artery damage during heart procedures.

What are the risks of this procedure?

While the goal of the procedure was to fix a heart rhythm, it resulted in a serious injury to a main artery. This caused the patient to become unstable and required an emergency bypass surgery. You should talk to your doctor about the specific risks and benefits of any heart procedure for your situation.

Study Details

Study typeGuideline

EvidenceLevel 5

PublishedSep 2026

View Original Abstract ↓

Premature ventricular contraction (PVC) ablation via retrograde aortic access is generally safe, but iatrogenic left main coronary artery (LMCA) dissection is a rare and potentially catastrophic complication. This case adds to the literature by describing LMCA dissection during PVC ablation managed with primary emergent coronary artery bypass grafting (CABG) rather than percutaneous coronary intervention (PCI), guided by intravascular ultrasound (IVUS) and Heart Team decision-making. A 60-year-old man with symptomatic, medication-refractory monomorphic PVCs (17.4% burden with nonsustained ventricular tachycardia) and preserved left ventricular function underwent elective PVC ablation via retrograde aortic access. Shortly after successful ablation at the aortomitral continuity, he developed sudden excruciating chest pain and anterior ST-segment elevation with hemodynamic instability. Emergent coronary angiography suggested LMCA dissection with occlusion of the proximal left anterior descending (LAD) artery and near-occlusive involvement of the proximal ramus intermedius. Balloon angioplasty restored limited flow, and intravascular ultrasound (IVUS) demonstrated an ostial LMCA dissection extending into both branches with true lumen compression and a heavily calcified proximal LAD segment, making complex LMCA bifurcation stenting high risk. After rapid Heart Team consultation, the patient underwent emergent CABG with left internal mammary artery (LIMA)–LAD and saphenous vein grafts to the ramus intermedius branch of the LMCA, along with intra-aortic balloon pump support. He was extubated and weaned off mechanical support on postoperative day 1 and discharged home on day 8; follow-up at 3 months revealed reduced ejection fraction (25%–30%) managed by advanced heart failure services. This case highlights mechanical LMCA ostial injury as a rare complication of retrograde PVC ablation and highlights the importance of immediate recognition of ST-segment elevation, emergent coronary angiography, and early involvement of a multidisciplinary Heart Team. IVUS is crucial to define dissection extent. When ostial or bifurcation LMCA dissection occurs in the setting of hemodynamic compromise and calcified, stent-unfavorable anatomy, guideline-directed emergent CABG can provide definitive and potentially life-saving revascularization.

Retrograde PVC ablation can cause rare but serious iatrogenic left main coronary artery dissectionRare heart complication occurs during procedure to treat heart rhythm

Common questions

Study Details

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Retrograde PVC ablation can cause rare but serious iatrogenic left main coronary artery dissectionRare heart complication occurs during procedure to treat heart rhythm

Common questions

Study Details

Dual antiplatelet therapy reduces all-cause death but not MACE or myocardial infarction in MINOCA

Dual antiplatelet therapy shows survival benefits for MINOCA patients

Clinical research that matters. Delivered to your inbox.

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