Toshihiro Nakamura1, Mitsuru Takami1, Koji Fukuzawa2, Kunihiko Kiuchi2, Hiroyuki Kono3, Atsushi Kobori3, Yuichiro Sakamoto4, Ryuta Watanabe5, Yasuo Okumura5, Soichiro Yamashita6, Kohei Yamashiro6, Koji Miyamoto7, Kengo Kusano7, Takashi Kanda8, Masaharu Masuda8, Kazuyasu Yoshitani9, Akihiro Yoshida10, Yasutaka Hirayama11, Kazumasa Adachi11, Takanao Mine12, Akira Shimane13, Masafumi Takeda14, Asumi Takei14, Katsunori Okajima15, Ryudo Fujiwara16, Ken-Ichi Hirata2. 1. Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine. 2. Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine. 3. Department of Cardiology, Kobe City Medical Center General Hospital. 4. Department of Cardiovascular Medicine, Toyohashi Heart Center. 5. Division of Cardiology, Department of Medicine, Nihon University of Medicine. 6. Heart Rhythm Center, Takatsuki General Hospital. 7. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center. 8. Kansai Rosai Hospital Cardiovascular Center. 9. Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center. 10. Department of Cardiology, Kita-Harima Medical Center. 11. Department of Cardiology, Akashi Medical Center. 12. Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine. 13. Department of Cardiology, Himeji Cardiovascular Center. 14. Department of Cardiology, Kobe Rosai Hospital. 15. Department of Cardiology, Kakogawa Central City Hospital. 16. Cardiovascular Division, Osaka Saiseikai Nakatsu Hospital.
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.
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.