Nitroglycerin to Ameliorate Coronary Artery Spasm During Focal Pulsed-Field Ablation for Atrial Fibrillation

Result code in IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00023884%3A_____%2F24%3A00009904" target="_blank" >RIV/00023884:_____/24:00009904 - isvavai.cz</a>

Result on the web

<a href="https://www-sciencedirect-com.ezproxy.lib.cas.cz/science/article/abs/pii/S2405500X24000112?via%3Dihub" target="_blank" >https://www-sciencedirect-com.ezproxy.lib.cas.cz/science/article/abs/pii/S2405500X24000112?via%3Dihub</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1016/j.jacep.2023.12.015" target="_blank" >10.1016/j.jacep.2023.12.015</a>

Result language

angličtina

Original language name

Nitroglycerin to Ameliorate Coronary Artery Spasm During Focal Pulsed-Field Ablation for Atrial Fibrillation

Original language description

BACKGROUND In treating atrial fibrillation, pulsed - field ablation (PFA) has comparable ef ficacy to conventional thermal ablation, but with important safety advantages: no esophageal injury or pulmonary vein stenosis, and rare phrenic nerve injury. However, when PFA is delivered in proximity to coronary arteries using a pentaspline catheter, which generates a broad electrical field, severe vasospasm can be provoked. OBJECTIVES The authors sought to study the vasospastic potential of a focal PFA catheter with a narrower electrical field and develop a preventive strategy with nitroglycerin. METHODS During atrial fibrillation ablation, a focal PFA catheter was used for cavotricuspid isthmus ablation. Angiography of the right coronary artery (some with fractional flow reserve measurement) was performed before, during, and after PFA. Beyond no nitroglycerin (n = 5), and a few testing strategies (n = 8), 2 primary nitroglycerin administration strategies were studied: 1) multiple boluses (3-2 mg every 2 min) into the right atrium (n =10), and 2) a bolus (3 mg) into the right atrium with continuous peripheral intravenous infusion (1 mg/min; n = 10). RESULTS Without nitroglycerin, cavotricuspid isthmus ablation provoked moderate -severe vasospasm in 4 of 5 (80%) patients (fractional flow reserve 0.71 +/- 0.08). With repetitive nitroglycerin boluses, severe spasm did not occur, and mild -moderate vasospasm occurred in only 2 of 10 (20%). Using the bolus + infusion strategy, severe and mild -moderate spasm occurred in 1 and 3 of 10 patients (aggregate 40%). No patient had ST -segment changes. CONCLUSIONS Ablation of the cavotricuspid isthmus using a focal PFA catheter routinely provokes right coronary vasospasm. Pretreatment with high doses of parenteral nitroglycerin prevents severe spasm. (J Am Coll Cardiol EP 2024;10:885 -896) (c) 2024 by the American College of Cardiology Foundation.

Czech name

—

Czech description

—

Type

J_imp - Article in a specialist periodical, which is included in the Web of Science database

CEP classification

—

OECD FORD branch

30201 - Cardiac and Cardiovascular systems

Project

—

Continuities

N - Vyzkumna aktivita podporovana z neverejnych zdroju

Publication year

2024

Confidentiality

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Name of the periodical

JACC: Clinical Electrophysiology

ISSN

2405-500X

e-ISSN

—

Volume of the periodical

10

Issue of the periodical within the volume

5

Country of publishing house

US - UNITED STATES

Number of pages

12

Pages from-to

885-896

UT code for WoS article

001246649500001

EID of the result in the Scopus database

2-s2.0-85187574086