1. Cardiac Catheterization Complication

2. Cath Lab Complications
Death
AMI
Dysrhythmia
Stroke
Bleeding
Hematoma
Vascular Injury
Contrast Induced Nephrotoxicity
Allergic reactions/Anaphylaxis
Pulmonary Edema
Air/clot embolism
Renal Failure (CIN)
Vagal reaction

3. Arrhythmias Arrhythmias and conduction disturbances
Premature ventricular contractions
VT and V-Fib
Atrial arrhythmias
Bradycardia
Varying clinical consequences depending upon severity of coronary artery disease, valvular heart disease, LV dysfunction, LVEDP

4. Premature Ventricular Contractions
Can be common without any clinical significance
Can be induced by catheter introduction into right or left ventricle

5. Ventricular Tachycardia and Ventricular Fibrillation
Results from excess catheter manipulation and intracoronary contrast injection (esp. in RCA)
Still occurs with contrast media if prolonged injection or performed with partially damped pressures
Incidence is higher in patients with baseline prolonged QT interval
Refractory ventricular ectopy is seen in the setting of profound transmural ischemia or early myocardial infarction

6. Ventricular Tachycardia and Ventricular Fibrillation..
If run of ventricular tachycardia initiated, the offending catheter must be repositioned immediately so that baseline cardiac rhythm is restored
Ventricular fibrillation or unstable ventricular tachycardia should be treated with prompt electrical cardioversion
Hemodynamically stable VT can be treated pharmacologically with lidocaine, amiodarone or procainamide
MgSO4 in patients with Torsades

7. Atrial Arrhythmias
Pre atrial contractions in response to catheter placement in or out of right atrium
Subsided when catheter is repositioned
May progress to atrial flutter and A-Fib in sensitive patients
Atrial flutter usually well tolerated
Usually do not require immediate treatment unless they produce hemodynamic instability
In patients with mitral stenosis, hypertrophic cardiomyopathy and diastolic LV dysfunction

8. Atrial Arrhythmias..
Treated with burst atrial pacing, electrical or pharmacological cardioversion ( Beta blocker, calcium channel blockers)
Care must be taken as catheter advancement into the ventricle can trigger VF
Atrial fibrillation- can results in rapid ventricular response and loss of atrial systole- results in hypotension
Synchronized cardioversion immediately if hemodynamic instability

9. Atrial Arrhythmias..
Other narrow complex tachycardia e.g., paroxysmal supraventricular tachycardia can be treated with vagal maneuver (carotid sinus message), IV adenosine, beta blocker, verapamil, or amiodarone
Synchronized cardioversion if prolonged episode or producing hemodynamic instability

10. Bradycardia
Can be secondary to the injection of contrast into the right coronary artery
Can occur with contrast media if prolonged injection in the RCA or performed with partially damped pressures
Forceful coughing can help clear the contrast, support perfusion, and restore normal cardiac rhythm

11. Vasovagal Reaction
Vasovagal reactions- include bradycardia, hypotension, yawning and/or sweating
Suspected when bradycardia is prolonged
Seen in 3% of patients especially if they have pain or anxious in setting of hypovolemia
Can be the early sign of cardiac perforation
Landau et al. quoted as more than 80% of such reactions occurred as vascular access was being obtained, with 16% occurring during sheath removal
Prevented by pre-procedural sedation and administration of adequate local anesthetic before catheter insertion
Rx: volume administration, atropine and removal of painful stimulus
Landau C, Lange RA, Glamann DB, Willard JE, Hillis LD. Vasovagal reactions in the cardiac catheterization laboratory. Am J Cardiol 1993;73:95.

12. Prevention of Complications
Proper patient preparation
Attention to details
Experience
Skills

13. Summary
Although procedures may seem routine, there are no routine procedures
Monitor all patients closely
Never force equipment
Always notify physician of complications

14. Thank You!