Abstract
Reddy et al (Circulation September 22, 2022; https://doi.org/10.1161/CIRCULATIONAHA.122.061497, PMID 36134574) evaluated coronary artery vasospasm related to pulse field ablation (PFA) lesions remote from and adjacent to coronary arteries. During atrial fibrillation ablation, coronary angiography was performed before, during, and after pulsed field applications including (1) those remote from the coronary arteries such as pulmonary vein isolation (n = 25 patients) and left atrial posterior wall ablation (n = 5) and (2) ablation of the cavotricuspid isthmus (CTI) (n = 20). During pulmonary vein isolation and left atrial posterior wall ablation, coronary spasm did not occur. CTI ablation provoked severe subtotal vasospasm in 5 of 5 consecutive patients (100%). This was relieved by intracoronary nitroglycerin in 5.5 ± 3.5 minutes without ST-segment elevation. No patient had severe spasm if administered intravenously or intracoronary before treatment. The authors conclude that coronary vasospasm was not provoked during PFA at locations remote from coronary arteries. When delivered adjacent to a coronary artery, PFA routinely provokes subclinical vasospasm that is attenuated by nitroglycerin.
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