Seri Amith Reddy, Talaei Fahimeh, Ibrahim Mahmoud, Hassan Mustafa
Internal Medicine, McLaren Flint, Michigan State University (MSU) College of Human Medicine, Flint, USA.
Cardiology, McLaren Flint, Michigan State University (MSU) College of Human Medicine, Flint, USA.
Cureus. 2024 Jan 8;16(1):e51902. doi: 10.7759/cureus.51902. eCollection 2024 Jan.
Although phrenic nerve and esophageal injury are commonly known risks associated with cryoablation, there is limited literature regarding coronary artery spasm (CAS), a serious and potentially fatal complication of cryoablation. We report the case of a 68-year-old Caucasian female who developed a left main CAS with a significant hemodynamic compromise during cryoablation. The patient, with a history of hyperlipidemia, hypertension, and symptomatic persistent atrial fibrillation, was admitted for elective catheter ablation for atrial fibrillation. During the ablation of the left superior pulmonary vein (LSPV), the patient developed severe hypotension and bradycardia. The patient's monitor revealed ST elevation, confirmed by a 12-lead ECG. Immediate coronary angiography revealed the left main coronary spasm, which improved with nitroglycerine administration with resolution of ST elevation and return of the patient's hemodynamics to stability. The patient's left main CAS was induced by cryoablation of LSPV. Literature on atrial fibrillation ablation-induced CAS is scant, but a Japanese study has shown that it occurs more commonly in cryoablation than in radiofrequency, hot balloon, or laser ablation. The study showed LSPV as the most common site of ablation right before the spasms happened. Further studies about this topic are needed to delineate further the risk factors and the precautions that could prevent CAS. In the meantime, prompt recognition and appropriate intervention are critical for a good patient outcome.
虽然膈神经和食管损伤是冷冻消融常见的已知风险，但关于冠状动脉痉挛（CAS）这一冷冻消融严重且可能致命的并发症的文献有限。我们报告一例68岁白种女性患者，其在冷冻消融过程中发生左主干CAS并伴有严重血流动力学损害。该患者有高脂血症、高血压病史及症状性持续性房颤，因择期房颤导管消融入院。在左上肺静脉（LSPV）消融过程中，患者出现严重低血压和心动过缓。患者监护仪显示ST段抬高，12导联心电图证实。立即行冠状动脉造影显示左主干冠状动脉痉挛，给予硝酸甘油后痉挛改善，ST段抬高消失，患者血流动力学恢复稳定。患者的左主干CAS是由LSPV冷冻消融诱发的。关于房颤消融诱发CAS的文献很少，但一项日本研究表明，与射频、热球囊或激光消融相比，CAS在冷冻消融中更常见。该研究表明LSPV是痉挛发生前最常见的消融部位。需要进一步研究该主题以进一步明确危险因素及可预防CAS的预防措施。同时，迅速识别和适当干预对患者取得良好预后至关重要。
