Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843

This article has now been updated. Please use the final version.

Incidence and Characteristics of Coronary Artery Spasms Related to Atrial Fibrillation Ablation Procedures ― Large-Scale Multicenter Analysis ―
Toshihiro NakamuraMitsuru TakamiKoji FukuzawaKunihiko KiuchiHiroyuki KonoAtsushi KoboriYuichiro SakamotoRyuta WatanabeYasuo OkumuraSoichiro YamashitaKohei YamashiroKoji MiyamotoKengo KusanoTakashi KandaMasaharu MasudaKazuyasu YoshitaniAkihiro YoshidaYasutaka HirayamaKazumasa AdachiTakanao MineAkira ShimaneMasafumi TakedaAsumi TakeiKatsunori OkajimaRyudo FujiwaraKen-ichi Hirata
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Article ID: CJ-20-1096

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Abstract

Background:Coronary artery spasms (CASs), which can cause angina attacks and sudden death, have been recently reported during catheter ablation. The aim of the present study was to report the incidence, characteristics, and prognosis of CASs related to atrial fibrillation (AF) ablation procedures.

Methods and Results:The AF ablation records of 22,232 patients treated in 15 Japanese hospitals were reviewed. CASs associated with AF ablation occurred in 42 of 22,232 patients (0.19%). CASs occurred during ablation energy applications in 21 patients (50%). CASs also occurred before ablation in 9 patients (21%) and after ablation in 12 patients (29%). The initial change in the electrocardiogram was ST-segment elevation in the inferior leads in 33 patients (79%). Emergency coronary angiography revealed coronary artery stenosis and occlusions, which were relieved by nitrate administration. No air bubbles were observed. A comparison of the incidence of CASs during pulmonary vein isolation between the different ablation energy sources revealed a significantly higher incidence with cryoballoon ablation (11/3,288; 0.34%) than with radiofrequency catheter, hot balloon, or laser balloon ablation (8/18,596 [0.04%], 0/237 [0%], and 0/111 [0%], respectively; P<0.001). CASs most often occurred during ablation of the left superior pulmonary vein. All patients recovered without sequelae.

Conclusions:CASs related to AF ablation are rare, but should be considered as a dangerous complication that can occur anytime during the periprocedural period.

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© 2021 THE JAPANESE CIRCULATION SOCIETY

This article is licensed under a Creative Commons [Attribution-NonCommercial-NoDerivatives 4.0 International] license.
https://creativecommons.org/licenses/by-nc-nd/4.0/
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