Severe coronary artery spasm during left atrial appendage closure plus catheter ablation for atrial fibrillation: case presentation

• Published in: BMC cardiovascular disorders Vol. 22; no. 1; pp. 38 - 5
• Main Authors: Xie, Xin, Chen, Zijun, Luo, Yu, Li, Xiaorong, Zhou, Jian, Yu, Jinbo, Yang, Bing
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 11.02.2022; BioMed Central; BMC
• Subjects: Ablation; Aged; Angiography; Atrial Appendage - physiopathology; Atrial Appendage - surgery; Atrial fibrillation; Atrial Fibrillation - diagnosis; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Blood clots; Blood pressure; Cardiac arrhythmia; Care and treatment; Case Report; Catheter ablation; Catheter Ablation - adverse effects; Catheters; Coronary Angiography; Coronary artery; Coronary artery spasm; Coronary vasospasm; Coronary Vasospasm - diagnostic imaging; Coronary Vasospasm - drug therapy; Coronary Vasospasm - etiology; Coronary Vasospasm - physiopathology; Coronary vessels; Coronary Vessels - diagnostic imaging; Coronary Vessels - drug effects; Coronary Vessels - physiopathology; Development and progression; Diltiazem; Dosage and administration; Electrocardiography; Embolisms; Fibrillation; General anesthesia; Heart rate; Humans; Hypertension; Intubation; Left atrial appendage closure; Male; Medical imaging; Nitroglycerin; Patients; Pulmonary Veins - physiopathology; Pulmonary Veins - surgery; Radiofrequency ablation; Sodium chloride; Stents; Tachycardia; Treatment Outcome; Vasoconstriction - drug effects; Vasodilator Agents - therapeutic use; Vein & artery diseases; Ventricle; China; Case report; Atrial fibrillation; Catheter ablation; Left atrial appendage closure; Coronary artery spasm
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-022-02483-2

Left atrial appendage closure (LAAC) combined with radiofrequency catheter ablation (RFCA) as a hybrid procedure is commonly performed to treat atrial fibrillation (AF). Although this treatment carries a low risk of coronary artery spasm (CAS), and has never been observed in LAAC procedure, caution still needed to be taken. We presented a case of CAS that occurred in an AF patient during the hybrid procedure. The patient was a 65-year-old man with paroxysmal AF who developed CAS during RFCA and LAAC. In this case, LAAC was performed ahead of RFCA. After atrial septal puncture, the occluder was advanced into left atrium through delivery sheath, and successfully deployed in the LAA. After verifying the assessment of "PASS" criteria, we decided to release the device. However, before releasing the occluder in LAAC, the patient's blood pressure (BP) fell to 70/45 mmHg with heart rate (HR) drop and ST-segment elevation in II, III, and aVF and reciprocal ST-segment depression in I and aVL. Isotonic sodium chloride load was administered. After 3 min, the BP and HR raised, and ST-segment returned to normal. The occluder was successfully released after the stable condition of the patient. Then, RFCA was sequentially performed. When isolating the right pulmonary veins, the patient's BP and HR fell again with ST-segment elevation in inferior leads. Spontaneous ventricular tachycardia and fibrillation developed rapidly and defibrillation was performed immediately with success. Coronary angiography revealed the obstruction of the right coronary artery which disappeared completely after intracoronary nitroglycerin injection (1 mg). Under systemic diltiazem infusion, the RFCA procedure was accomplished. After the procedure, the patient recovered without any neurologic deficit, and CAS has never recurred with isosorbide mononitrate treatment during follow-up. CAS is a rare complication associated with AF hybrid procedure. Attention should be paid to this rare but potentially life-threatening complication.