Pc-577-02 a Case of Coronary Artery Vasospasm; A Rare Complication of Vein of Marshall Ethanol Infusion for Atrial Fibrillation

Maeda, Shin; Okishige, Kaoru; Liang, Jackson J.; Arroyo, Ruben Casado; Kawabata, Mihoko; Atarashi, Hirotsugu; Hirao, Kazuyuki

doi:10.1016/j.hrthm.2022.03.692

Cited by 2 publications

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“…CAS during RF ablation of AF has been previously described in other reports 5 with an estimated incidence of about 0.3% in a large Japanese cohort of patients. 6 CAS was also reported with the use of cryoballoon 7 and after vein of Marshall ethanol infusion 8 for AF ablation. Proposed mechanisms of CAS related to the ablation procedure include direct thermal effects on the coronary artery, indirect effects of cryoenergy-induced blood cooling, and autonomic nervous system imbalance.…”

Section: Discussionmentioning

confidence: 93%

Multivessel coronary spasm triggered by ganglionated plexi stimulation during atrial fibrillation radiofrequency catheter ablation: a case report

Innocentiis¹,

Astore²,

Giannantonio

et al. 2023

European Heart Journal - Case Reports

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Background Atrial fibrillation is the most common sustained cardiac arrhythmia in adults and it is associated with a high burden of mortality and morbidity worldwide. Atrial fibrillation can be managed with rate-control or rhythm-control strategies. The latter is increasingly used to improve symptoms and prognosis in selected patients, especially after the development of catheter ablation. Although this technique is generally considered safe, it is not free from rare but life-threatening procedure-related adverse events. Among these, coronary artery spasm is an uncommon but potentially fatal complication that requires immediate diagnosis and treatment. Case summary We report a case of severe multivessel coronary artery spasm triggered by ganglionated plexi stimulation during pulmonary vein isolation with radiofrequency catheter ablation in a patient with persistent atrial fibrillation, promptly resolved after intracoronary nitrate administration. Discussion Although rare, coronary artery spasm is a serious complication of atrial fibrillation catheter ablation. Immediate invasive coronary angiography is key for both diagnosis confirmation and treatment of such dangerous condition. As the number of invasive procedures increases, it is important that both interventional and general cardiologists are aware of possible procedure-related adverse events.

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Section: Discussionmentioning

confidence: 93%

Multivessel coronary spasm triggered by ganglionated plexi stimulation during atrial fibrillation radiofrequency catheter ablation: a case report

Innocentiis¹,

Astore²,

Giannantonio

et al. 2023

European Heart Journal - Case Reports

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“…Moreover, a meta-analysis conducted by He et al (7) also revealed that VOM-ABL procedure was feasible, effective, and safe by reducing AF/AT recurrence rate without increasing the risk of cardiac tamponade and pericardial effusion. However, challenges still remained, which included few studies providing reliable conclusion due to short-term follow-up (less than one-year) (24,25), limited to case reports (26,27) and lack of control group (single-arm study) (28)(29)(30).…”

Section: Discussionmentioning

confidence: 99%

The Long-Term Outcomes of Ablation With Vein of Marshall Ethanol Infusion vs. Ablation Alone in Patients With Atrial Fibrillation: A Meta-Analysis

Sun

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThe long-term outcomes of ablation with vein of Marshall ethanol infusion (VOM-ABL) compared with ablation alone in patients with atrial fibrillation (AF) remains elusive. We aimed to explore whether VOM-ABL showed better long-term benefits and screen the potential determinants of outcome impact of VOM-ABL procedure.MethodsPubMed, Cochrane Library, Web of Science, and Embase were searched up to 1st September 2021. Studies comparing the long-term (one-year or longer) outcomes between VOM-ABL and ablation alone were included. Subgroup analysis identified potential determinants for VOM-ABL procedure.ResultsCompared with ablation alone, VOM-ABL was associated with a significantly higher rate of long-term freedom from AF/AT (risk ratio [RR], 1.28; 95% confidence interval [CI], 1.12–1.47; p = 0.00) and successful mitral isthmus (MI) block (RR, 1.52; 95% CI, 1.16–1.99; p = 0.00), whereas, there was no significant difference in pericardial effusion, stroke/transient ischemic attack (TIA), and all-cause death. Subgroup analysis identified two significant treatment-covariate interactions: one was ablation strategy subgroup (pulmonary vein isolation plus linear and/or substrate ablation [PVI+]; RR, 1.41; 95% CI, 1.27–1.56 vs. PVI; RR, 1.05; 95% CI, 0.92–1.19, p = 0.00 for interaction) for freedom from AF/AT, while the other was VOM-ABL group sample size subgroup (≥ 100; RR, 1.98; 95% CI, 1.24–3.17 vs. <100; RR, 1.20; 95% CI, 1.10–1.30, p = 0.04 for interaction) for MI block.ConclusionsThis meta-analysis demonstrates that VOM-ABL has superior efficacy and comparable safety over ablation alone in AF patients with long-term follow-up. Moreover, PVI+ and VOM-ABL group sample size ≥ 100 may be associated with a great impact on freedom from AF/AT and MI block, respectively.

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Pc-577-02 a Case of Coronary Artery Vasospasm; A Rare Complication of Vein of Marshall Ethanol Infusion for Atrial Fibrillation

Cited by 2 publications

References 0 publications

Multivessel coronary spasm triggered by ganglionated plexi stimulation during atrial fibrillation radiofrequency catheter ablation: a case report

Multivessel coronary spasm triggered by ganglionated plexi stimulation during atrial fibrillation radiofrequency catheter ablation: a case report

The Long-Term Outcomes of Ablation With Vein of Marshall Ethanol Infusion vs. Ablation Alone in Patients With Atrial Fibrillation: A Meta-Analysis

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