Incidence and Characteristics of Coronary Artery Spasms Related to Atrial Fibrillation Ablation Procedures　― Large-Scale Multicenter Analysis ―

Abstract

A trial fibrillation (AF) ablation procedures are generally effective and safe; however, devastating complications occasionally occur. Coronary artery spasms (CASs) have recently been reported as a complication of AF ablation, and some patients develop serious Editorial p ????

Perioperative coronary artery spasms in patients undergoing catheter ablation of atrial fibrillation

“…However, in our study, 7 out of 9 patients had CAS directly after the transseptal puncture before the RFCA, suggesting no effect of the thermal energy. Nakamura et al reported the CAS related to the AF ablation procedure [16]. CAS associated with AF ablation occurred in 0.19% (42 of 22,232) and CAS occurred before the ablation in 21%.…”

Coronary Artery Spasms and ST-Segment Elevation During Catheter Ablation of Pulmonary Vein Isolation ― Cause, Mechanism, and Management ―

“…In this issue of the Journal, based on their corresponding large-scale multicenter study, Nakamura et al 9 clearly demonstrate an incidence of CAS related to AF ablation of 0.19% (42/22,232), and CAS was the major cause of STE during PVI ablation. They performed emergency CAG in 88% (37/47) of the patients, and reversible spastic lesions occurred in all (29/29) patients who had continued STE during CAG.…”

“…9 Therefore, from the point of view of "STE" including air embolisms or thromboembolisms, the clinical manifestation of STE may be more frequently observed, as Tang et al described. 8 The Table shows a comparison of the results from Nakamura et al 9 and Tang et al 8 In the former study, an autonomic imbalance was highly suggested as the cause of the STE (CAS) because it particularly occurred during cryoablation of the left PVs. Cryoablation is thought to have a strong effect on the…”

“…That suggests air embolisms as the major cause of the STE; however, Nakamura et al also described 5 patients who had CAS immediately after septal puncture. 9 Tang et al considered that the passage of the catheter through the atrial septum, which is innervated profoundly by parasympathetic nerves, might irritate or damage the plexus. 8 Another possible explanation for the difference between the studies is the energy sources that they used.…”

“…Nakamura et al demonstrated 3 different risk factors for CAS during PVI: male sex, smoking, and a cooled energy source (cryoablation). 9 However, because they did not collect detailed patient data in those without CAS, the exact estimation of the risk for CAS or VF/CPA in the patients with all 3 conditions is impossible. Therefore, what we should know at the present time is that CAS is rare (0.2%) in general but possibly critical (17% of CAS, absolute risk of 0.03%) during the PVI procedure.…”