Hypertensive crisis during catheter ablation of atrial fibrillation in a patient with undiagnosed pheochromocytoma: a case report

INTRODUCTION: Pheochromocytoma is an unusual cause of hypertension accounting for 0.1% of cases. As the development of atrial fibrillation (AF) is tightly associated with hypertension, patients with pheochromocytoma are at higher risk for AF. CASE PRESENTATION: A 72-year-old woman with undiagnosed pheochromocytoma underwent catheter ablation of drug-resistant AF. Procedure-related external factors, such as prescription of a beta blocker without the preventive administration of an alpha blocker, use of contrast medium, administration of anaesthetics, and emotional and pain-related stress, caused a hypertensive crisis with acute left ventricular dysfunction during ablation procedure. After surgical resection of the adrenal tumour, sinus rhythm was maintained without antiarrhythmic drugs. DISCUSSION: Because hypertensive crisis can lead to life-threatening organ damage, electrophysiologists seeing patients with AF should always consider pheochromocytoma as a mechanism of hypertension and AF before proceeding to catheter ablation of the AF.