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July 3, 2026JACC Case ReportsOpen Access

Acetylcholine provocation under circulatory support confirms severe coronary vasospasm as the cause of refractory VF.

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Why the study?

Coronary vasospasm is an important but under-recognized cause of ventricular fibrillation, especially when angiography reveals a nonocclusive fixed coronary lesion.

Population

A 36-year-old man with recurrent chest pain and refractory ventricular fibrillation requiring VA-ECMO

Design

Case report

Key result

Acetylcholine provocation testing under circulatory support confirmed severe coronary vasospasm as the cause of refractory ventricular fibrillation in a patient with moderate fixed coronary stenosis.

Authors

HNHirokazu NishidoSHSatoshi HondaTNTeruo Noguchi

Discussion

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Member takes

Overview

Consider vasospasm in young VF survivors with moderate lesions; case report leaves open routine provocative testing.

Key Points

  • This case aims to illustrate the connection between coronary vasospasm and refractory ventricular fibrillation in the presence of fixed coronary stenosis.
  • A 36-year-old man with chest pain underwent coronary angiography revealing moderate stenosis.
  • Optical coherence tomography was used to evaluate plaque presence and thrombus, showing no rupture.
  • Acetylcholine provocation testing confirmed severe coronary vasospasm under circulatory support.
  • The patient required venoarterial extracorporeal membrane oxygenation due to refractory ventricular fibrillation.
  • Coronary angiography showed functionally significant ischemia despite nonocclusive lesions.
  • Provocation testing confirmed the diagnosis of coronary vasospasm underlying ventricular arrhythmias.

Study Design

Type

Case Report (n=1)

Structured PICO

P
Population
A 36-year-old man with refractory ventricular fibrillation requiring venoarterial extracorporeal membrane oxygenation.
I
Intervention
Acetylcholine provocation testing under circulatory support
O
Outcome
Diagnosis of severe coronary vasospasm

Coronary vasospasm should be considered and evaluated via provocation testing in survivors of malignant ventricular arrhythmias when fixed coronary findings do not fully explain the presentation.

Cite This Study

Nishido et al. (2026) conducted a case report in Refractory ventricular fibrillation (n=1). Acetylcholine provocation testing was evaluated. Acetylcholine provocation testing under circulatory support confirmed severe coronary vasospasm as the cause of refractory ventricular fibrillation in a patient with moderate fixed coronary stenosis.

synapsesocial.com/papers/6a4752ba5c29257aa257948dhttps://doi.org/10.1016/j.jaccas.2026.109104
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Also Consider

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

  1. 1“Spasms in Silence”: A case of coronary vasospasm‐induced ventricular fibrillation2024
  2. 2Coronary vasospasm as an etiology of recurrent ventricular fibrillation in the absence of coronary artery disease: a case report2021 · 6 citations
  3. 3Out-of-Hospital Cardiac Arrest due to Coronary Spasm with Recurrent Ventricular Fibrillation2020 · 1 citations
  4. 4Coronary Vasospasm Presenting in a Catastrophic Way2024 · 3 citations
  5. 5Aborted Sudden Cardiac Death from Vasospastic-Induced Ventricular Fibrillation with Normal Coronary Angiography: A Case Report and Review of the Literature2020 · 1 citations