Spastic occlusion of coronary artery during cryoballoon pulmonary vein isolation

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

“…The mechanism of CAS and risk factors of the perioperative ablation procedure have not been well established. According to several previous reports, the proposed mechanisms of CAS related to the ablation procedure include the direct thermal effects on the coronary artery [11], indirect effects via cryoenergy-induced blood cooling [5], and an autonomic nervous system imbalance caused by the affected ganglionated plexus through thermal or cooling injury [12][13][14][15]. 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.…”

Comparing Safety and Efficacy of Dabigatran and Factor Xa Inhibitors for Stroke Prevention in Hemophiliacs with Non-Valvular Atrial Fibrillation

“…Most cases in the literature have noted symptoms during the actual procedure, but symptoms in the post-operative period as in our case have been reported as well [9,11] . Most cases show good response with nitrates as was also seen in the presented case [12] . Of the cases evaluated in our literature search, no death or persistent morbidity were noted, although symptoms of frank syncope/aborted sudden death or new onset AV block may warrant evaluation for coronary spasm.…”

Coronary vasospasm caused by intravenous infusion of dexmedetomidine: Unrecognized pitfall of catheter ablation procedures of atrial fibrillation

“…Coronary vasospasm is a rare but potentially fatal complication associated with catheter ablation. According to several previous reports, the proposed mechanisms of coronary vasospasm related to catheter ablation include direct thermal effects on the coronary artery [3], indirect effects via cryoenergy-induced blood cooling [4], and an autonomic nervous system imbalance caused by the affected ganglionated plexus through a thermal or cooling injury [5][6][7][8]. It has been shown that a-2 adrenoreceptor-mediated vasoconstriction can involve the coronary circulation, especially in the presence of atherosclerosis and endothelial dysfunction [10].…”

“…It has been shown that a-2 adrenoreceptor-mediated vasoconstriction can involve the coronary circulation, especially in the presence of atherosclerosis and endothelial dysfunction [10]. It is thus possible that a stimulation of a-2 adrenergic receptors induced by dexmedetomidine causes a coronary vasospasm, and in fact, dexmedetomidine was used in the recently reported cases of coronary vasospasm that occurred during catheter ablation [6][7][8][9]. However, this remains merely a hypothesis, and there is no clinical evidence to support it at this time.…”

“…Among the available sedative drugs, dexmedetomidine-an a-2 adrenergic agonist with a short distribu-tion half-life-has been deemed a safe sedative drug providing sedation and analgesia with less respiratory depressant effects compared to other agents [1,2]. Regarding the potential complications of catheter ablation, case reports demonstrating coronary spasm as a potential lethal complication of catheter ablation for AF have emerged [3][4][5][6][7][8][9]. The occurrence of a coronary spasm during catheter ablation seems to be multifactorial, and its underlying mechanisms have not been fully determined.…”