Key result
Cryoballoon PVI is linked to delayed coronary artery spasm leading to reversible cardiac arrest.
Why the study?
Coronary artery spasm is a rare but recognised complication of AF ablation that may result in life-threatening arrhythmias.
Case Report (n=1)
This case highlights that delayed, recurrent, and diffuse coronary artery spasm is a rare but potentially catastrophic complication of cryoballoon AF ablation, emphasizing the need for continuous peri-procedural ECG monitoring.
Supports continuous ECG monitoring after cryoballoon AF ablation; leaves open the incidence and prevention of delayed diffuse spasm.
Background Pulmonary vein isolation (PVI) is recommended for rhythm control in selected patients with symptomatic atrial fibrillation (AF). Coronary artery spasm (CAS) is a rare but recognised complication of AF ablation and may result in life-threatening arrhythmias. Case Summary A 47-year-old man underwent cryoballoon PVI for symptomatic paroxysmal AF. Transient inferior ST-segment elevation occurred following left-sided PVI and resolved spontaneously. Shortly after completion of the procedure, recurrent ST-segment elevation developed, progressed to malignant ventricular arrhythmia and cardiac arrest, and emergency angiography demonstrated severe diffuse spasm affecting both coronary systems without obstructive disease. Return of spontaneous circulation occurred following spontaneous resolution of CAS before intracoronary nitrate administration. Ventricular function normalised within 24 hours. Recovery was complicated by transient right phrenic nerve palsy and persistent post-traumatic stress disorder. At 2-year follow-up, there was no recurrent AF on implantable loop recorder monitoring. Discussion This case highlights delayed, recurrent and diffuse CAS as a rare but potentially catastrophic complication of cryoballoon AF ablation. Continuous electrocardiographic monitoring in the peri-procedural period is essential. Although spontaneous resolution occurred in this case, previous reports support rapid access to intravenous or intracoronary nitrates. Emerging data from pulsed field ablation suggests that coronary vasospasm is not restricted to cryothermal energy and that nitroglycerin prophylaxis may reduce, but not abolish, risk.
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Nash et al. (2026) conducted a case report in Symptomatic paroxysmal atrial fibrillation (n=1). Cryoballoon pulmonary vein isolation was evaluated. Cryoballoon pulmonary vein isolation for atrial fibrillation was complicated by delayed, recurrent, and diffuse coronary artery spasm leading to cardiac arrest, which resolved spontaneously.
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