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Hori Y, Aoki H, Nakahara S. Editorial to "Atropine sulfate may be effective to recover the unstable hemodynamics in coronary artery spasms related to atrial fibrillation ablation procedures". J Arrhythm 2024; 40:1016-1017. [PMID: 39139878 PMCID: PMC11317649 DOI: 10.1002/joa3.13102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 08/15/2024] Open
Affiliation(s)
- Yuichi Hori
- Department of CardiologyDokkyo Medical University Saitama Medical CenterKoshigayaJapan
| | - Hideyuki Aoki
- Department of CardiologyDokkyo Medical University Saitama Medical CenterKoshigayaJapan
| | - Shiro Nakahara
- Department of CardiologyDokkyo Medical University Saitama Medical CenterKoshigayaJapan
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Kawai S, Okahara A, Tokutome M, Matsuura H, Mukai Y. Atropine sulfate may be effective to recover the unstable hemodynamics in coronary artery spasms related to atrial fibrillation ablation procedures. J Arrhythm 2024; 40:1013-1015. [PMID: 39139870 PMCID: PMC11317650 DOI: 10.1002/joa3.13090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/04/2024] [Accepted: 05/24/2024] [Indexed: 08/15/2024] Open
Abstract
Coronary artery spasms related to atrial fibrillation ablation procedures could cause lethal ventricular fibrillation or cardiopulmonary arrest. It may be useful to try intravenous atropine sulfate while preparing urgent coronary artery angiography in hemodynamically unstable coronary artery spasms cases to prevent development of the lethal arrhythmias.
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Affiliation(s)
- Shunsuke Kawai
- Department of Cardiovascular MedicineJapanese Red Cross Fukuoka HospitalFukuokaJapan
| | - Arihide Okahara
- Department of Cardiovascular MedicineJapanese Red Cross Fukuoka HospitalFukuokaJapan
| | - Masaki Tokutome
- Department of Cardiovascular MedicineJapanese Red Cross Fukuoka HospitalFukuokaJapan
| | - Hirohide Matsuura
- Department of Cardiovascular MedicineJapanese Red Cross Fukuoka HospitalFukuokaJapan
| | - Yasushi Mukai
- Department of Cardiovascular MedicineJapanese Red Cross Fukuoka HospitalFukuokaJapan
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Wang Z, Liang M, Sun J, Zhang J, Han Y. A New Hope for the Treatment of Atrial Fibrillation: Application of Pulsed-Field Ablation Technology. J Cardiovasc Dev Dis 2024; 11:175. [PMID: 38921675 PMCID: PMC11204042 DOI: 10.3390/jcdd11060175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/17/2024] [Accepted: 05/23/2024] [Indexed: 06/27/2024] Open
Abstract
In recent years, the prevalence of and mortality associated with cardiovascular diseases have been rising in most countries and regions. AF is the most common arrhythmic condition, and there are several treatment options for AF. Pulmonary vein isolation is an effective treatment for AF and is the cornerstone of current ablation techniques, which have one major limitation: even when diagnosed and treated at a facility that specializes in ablation, patients have a greater chance of recurrence. Therefore, there is a need to develop better ablation techniques for the treatment of AF. This article first compares the current cryoablation (CBA) and radiofrequency ablation (RFA) techniques for the treatment of AF and discusses the utility and advantages of the development of pulsed-field ablation (PFA) technology. The current research on PFA is summarized from three perspectives, namely, simulation experiments, animal experiments, and clinical studies. The results of different stages of experiments are summarized, especially during animal studies, where pulmonary vein isolation was carried out effectively without causing injury to the phrenic nerve, esophagus, and pulmonary veins, with higher safety and shorter incision times. This paper focuses on a review of various a priori and clinical studies of this new technique for the treatment of AF.
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Affiliation(s)
- Zhen Wang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang 110819, China;
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China; (M.L.); (J.S.); (J.Z.)
| | - Ming Liang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China; (M.L.); (J.S.); (J.Z.)
- National Key Laboratory of Frigid Zone Cardiovascular Diseases, Shenyang 110016, China
| | - Jingyang Sun
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China; (M.L.); (J.S.); (J.Z.)
| | - Jie Zhang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China; (M.L.); (J.S.); (J.Z.)
| | - Yaling Han
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China; (M.L.); (J.S.); (J.Z.)
- National Key Laboratory of Frigid Zone Cardiovascular Diseases, Shenyang 110016, China
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Kazatani T, Higaki A, Tanaka Y, Kawada Y. The potential effect of bepridil on vasospastic angina in atrial fibrillation patients undergoing catheter ablation. J Interv Card Electrophysiol 2023; 66:1559. [PMID: 35237918 DOI: 10.1007/s10840-022-01171-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Takuro Kazatani
- Department of Cardiology, Ehime Prefectural Central Hospital, 83, Kasuga-machi, Matsuyama, Matsuyama, Ehime, 790-0024, Japan
| | - Akinori Higaki
- Department of Cardiology, Ehime Prefectural Central Hospital, 83, Kasuga-machi, Matsuyama, Matsuyama, Ehime, 790-0024, Japan.
| | - Yuta Tanaka
- Department of Cardiology, Ehime Prefectural Central Hospital, 83, Kasuga-machi, Matsuyama, Matsuyama, Ehime, 790-0024, Japan
| | - Yoshitaka Kawada
- Department of Cardiology, Ehime Prefectural Central Hospital, 83, Kasuga-machi, Matsuyama, Matsuyama, Ehime, 790-0024, Japan
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Yarrarapu SNS, Shah P, Iskander B, Mestre A, Desai A, Shah S, Bhandari R, Ottun ARA, Bharti A, Vunnam D, Ouled Said A, Hsieh YC, Patel UK, Samala Venkata V. Epidemiology, Trends, Utilization Disparities, and Outcomes of Catheter Ablation and Its Association With Coronary Vasospasm Amongst Patients With Non-valvular Atrial Fibrillation: A Nationwide Burden of Last Decade. Cureus 2023; 15:e40649. [PMID: 37342301 PMCID: PMC10278971 DOI: 10.7759/cureus.40649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Catheter ablation (CA) is an important curative treatment for non-valvular atrial fibrillation (NVAF), however, nationwide data on its utilization and disparities is limited. Coronary vasospasm is a rare, life-threatening, peri-operative complication of CA with limited literature in Caucasians. METHODS We performed a retrospective study on adult hospitalizations in the USA from 2007 to 2017 by obtaining the data from National Inpatient Sample. The primary endpoints of our study were to identify the utilization rate of CA, disparities in utilization, and study the outcomes associated with CA. The secondary endpoints of the study were to identify the incidence of coronary vasospasm amongst patients who underwent CA, evaluate their association, and identify the predictors of coronary vasospasm. RESULTS From 35,906,946 patients with NVAF, 343641 (0.96%) underwent CA. Its utilization decreased from 1% in 2007 to 0.71% in 2017. Patients who underwent CA, compared to those without CA, fared better in terms of hospital length of stay, mortality rate, disability rate, and discharge to the non-home facility. Patients in the 50-75 years age group, Native Americans, those with private insurance, and median household income of 76-100th percentile were associated with higher odds of CA utilization. Urban teaching hospitals and large-bedded hospitals performed more ablations, while the Mid-West region fared lower than the South, the West, and the Northeast. The prevalence of coronary vasospasm was higher amongst CA in comparison without CA, however, in regression analysis, no significant association was demonstrated between CA and coronary vasospasm. CONCLUSION CA is an important treatment modality that is associated with improved clinical outcomes. Identification of factors associated with lower utilization of CA and its disparities will help to mitigate the burden associated with NVAF.
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Affiliation(s)
| | - Parth Shah
- Hospital Medicine, Tower Health Medical Group, Reading, USA
| | - Beshoy Iskander
- Internal Medicine, Bon Secours Mercy Health - St. Elizabeth Youngstown Hospital (NEOMED), Youngstown, USA
| | - Andrea Mestre
- Internal Medicine, Universidad del Rosario, Bogota, COL
| | - Aditya Desai
- Internal Medicine, University of California Riverside School of Medicine, Riverside, USA
| | - Shiv Shah
- Internal Medicine, Government Medical College, Surat, Surat, IND
| | - Renu Bhandari
- Medicine, Manipal College of Medical Sciences, Pokhara, NPL
| | | | - Anmol Bharti
- Internal Medicine, University College of Medical Sciences, Delhi, IND
| | - Deepika Vunnam
- Internal Medicine, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Chinna Avutapalli, IND
| | | | - Ya-Ching Hsieh
- Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Urvish K Patel
- Public Health and Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
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O’Brien B, Reilly J, Coffey K, González-Suárez A, Quinlan L, van Zyl M. Cardioneuroablation Using Epicardial Pulsed Field Ablation for the Treatment of Atrial Fibrillation. J Cardiovasc Dev Dis 2023; 10:238. [PMID: 37367403 PMCID: PMC10299113 DOI: 10.3390/jcdd10060238] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/28/2023] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia affecting millions of people worldwide. The cardiac autonomic nervous system (ANS) is widely recognized as playing a key role in both the initiation and propagation of AF. This paper reviews the background and development of a unique cardioneuroablation technique for the modulation of the cardiac ANS as a potential treatment for AF. The treatment uses pulsed electric field energy to selectively electroporate ANS structures on the epicardial surface of the heart. Insights from in vitro studies and electric field models are presented as well as data from both pre-clinical and early clinical studies.
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Affiliation(s)
- Barry O’Brien
- AtriAN Medical Ltd., Unit 204, Business Innovation Centre, Upper Newcastle, H91 W60E Galway, Ireland
| | - John Reilly
- AtriAN Medical Ltd., Unit 204, Business Innovation Centre, Upper Newcastle, H91 W60E Galway, Ireland
| | - Ken Coffey
- AtriAN Medical Ltd., Unit 204, Business Innovation Centre, Upper Newcastle, H91 W60E Galway, Ireland
| | - Ana González-Suárez
- School of Engineering, University of Galway, H91 TK33 Galway, Ireland
- Translational Medical Device Lab, University of Galway, H91 YR71 Galway, Ireland
| | - Leo Quinlan
- Physiology and Cellular Physiology Research Laboratory, CURAM SFI Centre for Research in Medical Device, University of Galway, H91 TK33 Galway, Ireland
| | - Martin van Zyl
- Cardiac Electrophysiology, Royal Jubilee Hospital, Victoria, BC V8R 1J8, Canada
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Boo KY, Park SH, Park SK, Na C, Kim HJ. Cardiac arrest due to coronary vasospasm after sugammadex administration -a case report. Korean J Anesthesiol 2023; 76:72-76. [PMID: 35978452 PMCID: PMC9902188 DOI: 10.4097/kja.22335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/16/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Sugammadex is a widely used medication for the reversal of aminosteroid neuromuscular blockades. Although sugammadex is generally regarded to be safe, concerns about the risk of serious complications have emerged. CASE A 57-year-old man without a history of coronary disease was scheduled for general anesthesia to undergo cardiac radiofrequency catheter ablation due to symptomatic persistent atrial fibrillation and flutter. At the end of the procedure, he was given 400 mg of sugammadex. A little later, the electrocardiogram showed a sudden ST elevation on the inferior leads, followed by cardiac arrest. The urgent coronary angiography demonstrated total collapse of the right coronary artery. After two injections of intra-coronary nitroglycerin, the vasospasm of the right coronary artery was completely resolved. The patient recovered without sequelae and was discharged on postoperative day 5. CONCLUSIONS Clinicians should pay close attention to the potential risk of coronary vasospasm, even cardiac arrest, after sugammadex administration.
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Affiliation(s)
- Ki Yung Boo
- Department of Cardiology, Jeju National University Hospital, Jeju, Korea
| | - Sang Hyun Park
- Department of Anesthesiology and Pain Medicine, Jeju National University College of Medicine, Jeju, Korea
| | - Sun Kyung Park
- Department of Anesthesiology and Pain Medicine, Jeju National University College of Medicine, Jeju, Korea
| | - Changrock Na
- Department of Anesthesiology and Pain Medicine, Jeju National University Hospital, Jeju, Korea
| | - Hyun Jung Kim
- Department of Anesthesiology and Pain Medicine, Jeju National University College of Medicine, Jeju, Korea,Corresponding author: Hyun Jung Kim, M.D., Ph.D. Department of Anesthesiology and Pain Medicine, Jeju National University College of Medicine, 15 aran 13-gil, Jeju 63241, KoreaTel: +82-64-717-2026Fax: +82-64-717-1131
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De Innocentiis C, Astore P, Giannantonio M, Ienco V, Santamaria M. Multivessel coronary spasm triggered by ganglionated plexi stimulation during atrial fibrillation radiofrequency catheter ablation: a case report. Eur Heart J Case Rep 2023; 7:ytad007. [PMID: 36845832 PMCID: PMC9949709 DOI: 10.1093/ehjcr/ytad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/11/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
Background Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in adults, and it is associated with a high burden of mortality and morbidity worldwide. AF can be managed with rate-control or rhythm-control strategies. The latter is increasingly used to improve symptoms and prognosis in selected patients, especially after the development of catheter ablation. Although this technique is generally considered safe, it is not free from rare but life-threatening procedure-related adverse events. Among these, coronary artery spasm (CAS) is an uncommon but potentially fatal complication that requires immediate diagnosis and treatment. Case summary We report a case of severe multivessel CAS triggered by ganglionated plexi stimulation during pulmonary vein isolation with radiofrequency catheter ablation in a patient with persistent AF, promptly resolved after intracoronary nitrate administration. Discussion Although rare, CAS is a serious complication of AF catheter ablation. Immediate invasive coronary angiography is key for both diagnosis confirmation and treatment of such dangerous condition. As the number of invasive procedures increases, it is important that both interventional and general cardiologists are aware of possible procedure-related adverse events.
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Affiliation(s)
- Carlo De Innocentiis
- Arrhythmology and Electrophysiology Unit, Gemelli Molise Hospital, Largo Agostino Gemelli, 1, 86100 Campobasso (CB), Italy
| | - Pasquale Astore
- Arrhythmology and Electrophysiology Unit, Gemelli Molise Hospital, Largo Agostino Gemelli, 1, 86100 Campobasso (CB), Italy
| | - Maria Giannantonio
- Anesthesiology and Intensive Care Unit, Gemelli Molise Hospital, Largo Agostino Gemelli, 1, 86100 Campobasso (CB), Italy
| | - Vincenzo Ienco
- Interventional Cardiology Unit, Gemelli Molise Hospital, Largo Agostino Gemelli, 1, 86100 Campobasso (CB), Italy
| | - Matteo Santamaria
- Arrhythmology and Electrophysiology Unit, Gemelli Molise Hospital, Largo Agostino Gemelli, 1, 86100 Campobasso (CB), Italy
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Epicardial mapping complicated by multi-vessel coronary spasm and electrical storm. J Interv Card Electrophysiol 2022; 65:575-576. [PMID: 35856122 DOI: 10.1007/s10840-022-01303-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 07/07/2022] [Indexed: 12/13/2022]
Abstract
The case report describes a severe multi-vessel coronary spasm complicating the epicardial mapping in a patient with chronic Chagas cardiomyopathy.
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