Remote diffuse multi-coronary artery spasm following pulmonary vein and posterior wall isolation, using a focal monopolar pulsed field ablation catheter

Figures

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  Figure 1. Ablation maps. A: Poster-anterior (PA) view of the left atrium (LA), with evidence of low voltage areas on the posterior wall. B: Local activation time map of the posterior wall. C: Lateral and PA views of the left atrium, demonstrating ablation tags of the wide antral circumferential ablation with posterior wall isolation.

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  Figure 2. Polymorphic ventricular tachycardia on loop recorder and pads, followed by 12-lead ECGs. A: Polymorphic ventricular tachycardia (VT) retrieved from the patient loop recorder, identifying the onset time. B: Polymorphic VT on defibrillator pads trace, briefly self-terminating before restarting resulting in shock. C: A 12-lead ECG post return of spontaneous circulation, with an interventricular conduction delay and ST-segment elevation in the inferior leads with reciprocal ST depression in high lateral and anterior leads. D: ECG was repeated 3 minutes after B, demonstrating different territory ST segment changes, now in the anterior leads. ECG = electrocardiogram.

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  Figure 3. Coronary angiograms. A: demonstrates a caudal view of the emergent procedure left coronary and circumflex system, with dramatic improvement and caliber increase in a similar view in D. B: shows an acute cranial view of the left main and anterior descending artery system, which has multiple non-occlusive stenoses in a small caliber vessel. This contrasts dramatically with (E) in the second angiogram, where the arteries have returned to a pre-spasmodic state. C: Acute critical stenosis in the mid right coronary artery with TIMI 2 flow, during the emergent angiogram, with resolution and substantial caliber improvement in the second angiogram (F). TIMI = thrombolysis in myocardial infarction.