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June 12, 2026Frontiers in Cardiovascular MedicineOpen Access

Cardiac autonomic ganglion ablation resolves refractory post-PCI vasospastic angina in a single patient.

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Why the study?

Does catheter ablation of cardiac autonomic ganglia improve refractory coronary artery spasm in patients with heightened vagal tone after PCI?

Population

A 45-year-old male with recurrent chest pain after coronary stent implantation and refractory coronary artery spasm

Comparison

Catheter ablation of cardiac autonomic ganglia

Design

Case report

Follow-up

2-month follow-up

Key result

Cardiac autonomic ganglion ablation resulted in complete resolution of angina symptoms and marked attenuation of ergonovine-provoked coronary artery spasm at 2-month follow-up in a patient with refractory post-PCI vasospastic angina.

Authors

FQFuchao QuSZShanshan ZhangLXLi X

Discussion

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Member takes

Overview

Should not change post-stent angina management; case report leaves open spasm provocation testing in refractory Wellens'-like presentations.

Key Points

  • To assess the efficacy of cardiac autonomic ganglion ablation for refractory coronary artery spasm post-PCI in a patient with heightened vagal tone.
  • Performed catheter ablation of cardiac autonomic ganglia using a three-dimensional electroanatomical mapping system.
  • Conducted intracoronary ergonovine provocation testing before and after ablation to evaluate spasm response.
  • Followed up with the patient at 2 months post-ablation.
  • Post-ablation ergonovine testing showed markedly reduced coronary artery spasm with spontaneous resolution of symptoms.
  • Patient reported complete resolution of angina at the 2-month follow-up.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

Does catheter ablation of cardiac autonomic ganglia improve refractory coronary artery spasm in patients with heightened vagal tone after PCI?

P
Population
A 45-year-old male with refractory coronary artery spasm after PCI and heightened vagal tone, treated with cardiac autonomic ganglion ablation and followed for 2 months.
I
Intervention
Catheter ablation of cardiac autonomic ganglia (cardioneuroablation) targeting four major ganglionated plexi (left superior, left inferior, right anterior, right inferior) using an irrigated radiofrequency catheter under the guidance of a three-dimensional electroanatomical mapping system.
O
Outcome
Resolution of angina symptoms and attenuation of ergonovine-induced coronary artery spasm at 2-month follow-upsurrogate

Cardioneuroablation may serve as an effective non-pharmacological treatment option for refractory post-PCI coronary artery spasm driven by heightened vagal tone.

Limitations

  • Single case report lacking large-scale clinical validation
  • Increased vagal tone was suggested solely by indirect evidence without objective quantitative parameters
  • Short follow-up period precluded the evaluation of long-term post-ablation efficacy and potential risk of recurrence
  • Single case report lacking large-scale clinical studies
  • Increased vagal tone suggested solely by indirect evidence without quantitative parameters (e.g., heart rate variability, atropine test)
  • Short follow-up period precluding evaluation of long-term efficacy and recurrence risk

Cite This Study

Qu et al. (2026) conducted a case report in Refractory coronary artery spasm after PCI (n=1). Cardiac autonomic ganglion ablation was evaluated on Resolution of angina symptoms and coronary artery spasm. Cardiac autonomic ganglion ablation resulted in complete resolution of angina symptoms and marked attenuation of ergonovine-provoked coronary artery spasm at 2-month follow-up in a patient with refractory post-PCI vasospastic angina.

synapsesocial.com/papers/6a2bd1056550ea4541ffe7b3https://doi.org/10.3389/fcvm.2026.1867475
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Cardioneuroablation for coronary artery vasospasm: a case report2025
  2. 2Chronic refractory angina pectoris treated by bilateral stereotactic radiosurgical stellate ganglion ablation: first-in-man case report2021 · 9 citations
  3. 3SYMPATHETIC DENERVATION OF STELLATE GANGLION FOR MANAGEMENT OF PERSISTENT VENTRICULAR TACHYCARDIA: A CASE REPORT2024
  4. 4THERAPEUTIC CHALLENGES IN RESISTANT VASOSPASTIC ANGINA: A CASE REPORT2026
  5. 5Spinal Cord Stimulation for Refractory Chest Pain Without Objective Ischemia in a Patient With Prior Coronary Artery Bypass Grafting: A Case Report2026