Shocked Beyond the Field

Q: What is the clinical evidence from this study?

Study design: Editorial. Population: Coronary vasospasm associated with pulsed field ablation. Intervention: Pulsed field ablation (PFA).

Q: What does this research mean for the field?

Pulsed field ablation can trigger severe, anatomically remote multivessel coronary vasospasm independent of direct catheter-coronary proximity. Novelty: ClaimNovelty.CONTRADICTORY. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

K. R. Julian Chun; Melanie Gunawardene; Boris Schmidt

doi:10.1016/j.jaccas.2026.110359

September 1, 2026JACC Case ReportsOpen Access

Shocked Beyond the Field

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Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY-NC-ND

Why the study?

Coronary vasospasm associated with pulsed field ablation (PFA) is incompletely understood, particularly regarding mechanisms beyond direct energy delivery proximity to coronary arteries.

Key Points

To evaluate the mechanisms and clinical implications of remote, severe multivessel coronary vasospasm and cardiogenic shock occurring during pulsed field ablation.
Evaluated a clinical case report of severe multivessel coronary vasospasm and cardiogenic shock during pulsed field ablation (PFA).
Assessed spatial relationships between ablation sites and coronary arteries using fluoroscopy and computed tomography with the FARAVIEW Software Module (Boston Scientific).
Severe multivessel coronary vasospasm complicated by cardiogenic shock developed despite anatomical remoteness between PFA delivery sites and coronary arteries.
The findings demonstrate diffuse, nitrate-responsive vasospasm that challenges the concept of proximity-dependent coronary injury, pointing to potential non-local mechanisms such as autonomic ganglionated plexus modulation, endothelial perturbation, and hemolysis-associated nitric oxide scavenging.

PICO

P

Population

Coronary vasospasm associated with pulsed field ablation

I

Intervention / Comparator

Pulsed field ablation (PFA)

Implication

Case report reveals severe multivessel coronary vasospasm and cardiogenic shock in pulsed field ablation, highlighting vasomotor reactions beyond direct anatomical proximity.

Abstract

[Figure: see text]

Discussion

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Cite This Study

Chun et al. (2026) conducted an editorial in Coronary vasospasm associated with pulsed field ablation. Pulsed field ablation (PFA) was evaluated.

synapsesocial.com/papers/6ace6e0db52af824ab02bc53 https://doi.org/10.1016/j.jaccas.2026.110359

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Shocked Beyond the Field

Key Points

PICO

Implication

Abstract

Discussion

Cite This Study

Shocked Beyond the Field

Key Points

PICO

Implication

Abstract

Discussion

Cite This Study

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