Delayed coronary vasospasm after pulsed field ablation for pulmonary vein isolation despite avoidance of coronary-adjacent ablation sites

Figures

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  Figure 1. Post-ablation voltage maps and anatomic relationship between coronary arteries and PFA sites. Yellow dots indicate the point of PFA sites. A: Post-PFA voltage map in the posteroanterior (PA) view demonstrating complete pulmonary vein isolation without any unintended electrical effects or voltage attenuation in the posterior left atrial wall or other left atrial regions. B: Post-PFA voltage map in the anteroposterior (AP) view confirming durable electrical isolation of all 4 pulmonary veins. C: Distance between the left circumflex artery and the nearest PFA application at the anterior aspect of the left inferior pulmonary vein (14 mm). D: Distance between the right coronary artery and the nearest PFA application at the anterior aspect of the right superior pulmonary vein (58 mm). LCx = left circumflex coronary artery; LIPV = left inferior pulmonary vein; PFA = pulsed field ablation; RCA = right coronary artery; RSPV = right superior pulmonary vein.

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  Figure 2. Electrocardiographic changes associated with delayed vasospasm. A: Post-ablation ECG demonstrating sinus rhythm after completion of PFA-guided pulmonary vein isolation. B: ECG obtained 103 minutes after the procedure showing marked ST-segment elevation in leads II, III, and aVF with reciprocal change. C: ECG obtained 177 minutes after the procedure showing complete resolution of ischemic ST-T abnormalities. ECG = electrocardiogram; PFA = pulsed field ablation.