Pulsed-field ablation for atrial fibrillation resulted in generalized coronary vasospasm in 100% of Marshallese patients, compared to 0% treated with thermal ablation.
Cohort (n=12)
No
Does pulsed-field ablation increase the risk of generalized coronary vasospasm compared to thermal ablation in Marshallese patients undergoing atrial fibrillation ablation?
Pulsed-field ablation for atrial fibrillation in Marshallese patients was associated with a 100% incidence of severe generalized coronary vasospasm, highlighting a critical population-specific safety signal.
Absolute Event Rate: 100% vs 0%
BACKGROUND Generalized coronary vasospasm (Gen-CS) is a rare but potentially life-threatening complication of atrial fibrillation (AF) ablation, previously described primarily after thermal ablation in East Asian populations. Its occurrence and severity during pulsed-field ablation (PFA), and its relative risk compared with thermal energy sources, remain poorly defined. OBJECTIVES The purpose of this study was to compare the occurrence and clinical characteristics of Gen-CS during PFA vs thermal AF ablation in patients of Marshallese descent. METHODS We retrospectively identified consecutive Marshallese patients undergoing AF ablation at a single tertiary referral center. Patients treated with PFA or thermal ablation (cryoballoon or radiofrequency) were included. The primary outcome was Gen-CS, defined as diffuse multivessel coronary constriction remote from ablation sites associated with ischemic electrocardiographic changes and/or hemodynamic instability. RESULTS A total of 12 patients underwent AF ablation (5 PFA; 7 thermal 5 cryoballoon, 2 radiofrequency). Baseline cardiometabolic comorbidity burden was substantial and similar between groups. Gen-CS occurred in all PFA patients (5 of 5; 100%) and in none of the thermal patients (0 of 7; 0%). Events occurred despite no PFA energy delivery in proximity to coronary arteries. Two PFA cases developed transient intraprocedural ischemia that resolved with intravenous nitroglycerin. Three cases presented in delayed fashion with ischemia and ventricular fibrillation or bradycardic shock requiring vasopressors, intravenous or intracoronary nitroglycerin, and mechanical circulatory support. CONCLUSIONS In this Marshallese cohort, Gen-CS occurred universally after PFA but not after thermal ablation and was frequently clinically severe. These findings suggest population-specific susceptibility and raise the hypothesis that PFA may confer higher Gen-CS risk than thermal energies.
Nair et al. (Sun,) conducted a cohort in Atrial Fibrillation (n=12). Pulsed-field ablation vs. Thermal ablation (cryoballoon or radiofrequency) was evaluated on Generalized coronary vasospasm (Gen-CS). Pulsed-field ablation for atrial fibrillation resulted in generalized coronary vasospasm in 100% of Marshallese patients, compared to 0% treated with thermal ablation.