Coronary artery spasm complicated by atrial septal puncture: A case report.

RATIONALE: The occurrence of ST-segment elevation on electrocardiogram (ECG) during transseptal puncture in atrial fibrillation procedures is relatively uncommon, and its pathogenesis remains unclear. In this report, we clearly identified severe coronary artery spasm during atrial septal puncture as one of the causes of ECG ST-segment elevation.

PATIENT CONCERNS: A 66-year-old woman was admitted to the hospital due to "paroxysmal palpitations for 1 year, with worsening symptoms for 1 week." Both the admission ECG and previous ECGs diagnosed her with atrial fibrillation. Immediately after routine atrial septal puncture, she experienced a drop in blood pressure and abnormal ECG changes, leading to serious complications.

DIAGNOSES: Persistent atrial fibrillation.

INTERVENTIONS: Femoral artery puncture for coronary angiography indicated occlusion of the proximal right coronary artery. Percutaneous coronary intervention of the right coronary artery was immediately performed. During the operation, it was confirmed that there was combined spasm on the basis of coronary artery stenosis. Nitroglycerin and sodium nitroprusside were repeatedly intravenously injected, norepinephrine was intravenously infused, an intra-aortic balloon pump and a temporary pacemaker were implanted. Subsequently, a 4.0 × 18 mm coronary stent was implanted.

OUTCOMES: The patient's symptoms improved, with resolution of ST-segment elevation on the ECG, and blood pressure and heart rate increased. Ultimately, the patient was discharged after 12 days of hospitalization with improvement.

LESSONS: Coronary artery spasm after atrial septal puncture is rare, and most cases are transient and do not lead to serious complications. However, if the patient has concurrent fixed stenosis, it may cause persistent vasospasm, resulting in severe complications. Preoperative coronary angiography or coronary CTA is a necessary examination.