Pulsed-Field Ablation-Induced Coronary Vasospasm for Atrial Tachycardia Originating From the Lateral Tricuspid Annulus.

BACKGROUND

Pulsed-field ablation (PFA) is a novel nonthermal technique that achieves myocardial ablation with high tissue selectivity and fewer complications than conventional thermal methods. Coronary vasospasm has been increasingly reported with the Farawave catheter, but data on the PulseSelect system are limited.

CASE SUMMARY: A 67-year-old man with paroxysmal atrial fibrillation and atrial tachycardia (AT) underwent catheter ablation. Pulmonary vein isolation was successfully achieved with the PulseSelect system. Subsequent mapping localized the AT to the lateral tricuspid annulus. Radiofrequency ablation repeatedly terminated the AT but was followed by immediate reinduction, failing to provide durable elimination. PulseSelect PFA was then applied to the same site, resulting in immediate AT termination and complete noninducibility thereafter. However, repeat coronary angiography revealed 75% stenosis in the right coronary artery, consistent with vasospasm, which promptly resolved after intracoronary nitroglycerin administration.

DISCUSSION: This case demonstrates that PFA-induced coronary vasospasm can also occur with the PulseSelect system, often without electrocardiographic changes, warranting careful coronary assessment during ablation near atrioventricular annuli.

TAKE-HOME MESSAGE: When using the PulseSelect system for ablation of atrioventricular annulus-origin arrhythmias, silent coronary vasospasm can occur regardless of catheter design, necessitating vigilance near the coronary arteries.