Key result
Radiofrequency left pulmonary vein isolation repeatedly triggers severe coronary artery spasm via autonomic imbalance.
Case Report (n=1)
No
Highlights the rare but severe complication of coronary artery spasm during pulmonary vein isolation, emphasizing the need for preparedness and the potential role of autonomic nervous system imbalance.
Warrants vigilance for coronary spasm during left PVI; hypothesis-generating for autonomic imbalance and requires confirmation before practice implications.
Key Teaching Points•We should always be ready to cope with coronary artery spasm (CAS), although CAS during pulmonary vein isolation is a rare complication.•Major possible mechanisms behind the incidence of CAS could be direct thermal damage from radiofrequency (RF) energy or an imbalance in autonomic nervous system activity.•An imbalance in autonomic nervous system activity was the more possible mechanism, because catheter manipulation after the application of RF energy in the left atrium induced severe CAS repeatedly. •We should always be ready to cope with coronary artery spasm (CAS), although CAS during pulmonary vein isolation is a rare complication.•Major possible mechanisms behind the incidence of CAS could be direct thermal damage from radiofrequency (RF) energy or an imbalance in autonomic nervous system activity.•An imbalance in autonomic nervous system activity was the more possible mechanism, because catheter manipulation after the application of RF energy in the left atrium induced severe CAS repeatedly.
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Honda et al. (2018) conducted a case report in Paroxysmal atrial fibrillation and atrial flutter (n=1). Left pulmonary vein isolation (radiofrequency ablation) was evaluated. Left pulmonary vein isolation using radiofrequency energy repeatedly induced severe coronary artery spasm, likely due to an imbalance in autonomic nervous system activity.
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