Cardiac autonomic ganglion ablation for refractory coronary artery spasm after PCI: a case report

Figures

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  Figure 1. Comparison of 12-lead electrocardiograms during an attack and the resolution of chest pain. (A) During the onset of chest pain, T waves in leads V4–V6 exhibited pseudonormalization characterized by symmetrical and upright morphology (indicated by arrows); (B) during the asymptomatic period, T waves in leads V4–V6 appeared inverted or flattened.

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  Figure 2. Coronary angiographic images from two ergonovine provocation tests. (A) Following intracoronary injection of 50 µg ergonovine into the LCA, severe stenosis was observed in the LAD and LCX (indicated by arrows); (B) The vasospasm was completely relieved after intracoronary administration of 200 µg nitroglycerin; (C) Intracoronary injection of 50 µg ergonovine into the RCA; (D) No significant vasospasm was observed in the RCA. (E) Following catheter ablation of the GP, repeated intracoronary injection of 50 µg ergonovine into the LCA induced mild stenosis in the LAD and LCX; (F) The mild stenosis in the LAD and LCX resolved spontaneously. LCA, left coronary artery; LAD, left anterior descending artery; LCX, left circumflex artery; RCA, right coronary artery; GP, ganglionated plexi.

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  Figure 3. Schematic of catheter ablation targets for cardiac autonomic GP. Three-dimensional electroanatomical maps of the left atrium were reconstructed using the CARTO 3 mapping system. The left panel displays the anteroposterior view, and the right panel displays the posteroanterior view. Red dots represent the ablation sites. GP, ganglionated plexi.

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  Figure 4. Vagal response and heart rate recovery following left superior GP ablation. (A) A positive vagal response was elicited during the ablation of the left superior GP, with the heart rate decreasing to a minimum of approximately 40 bpm; (B) post-ablation, the sinus rate increased to 90 bpm. GP, ganglionated plexi.