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

Kód výsledku v 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>

Výsledek na webu

<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>

Jazyk výsledku

angličtina

Název v původním jazyce

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

Popis výsledku v původním jazyce

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.

Název v anglickém jazyce

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

Popis výsledku anglicky

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.

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

—

OECD FORD obor

30201 - Cardiac and Cardiovascular systems

Projekt

—

Návaznosti

N - Vyzkumna aktivita podporovana z neverejnych zdroju

Rok uplatnění

2024

Kód důvěrnosti údajů

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

Název periodika

JACC: Clinical Electrophysiology

ISSN

2405-500X

e-ISSN

—

Svazek periodika

10

Číslo periodika v rámci svazku

5

Stát vydavatele periodika

US - Spojené státy americké

Počet stran výsledku

12

Strana od-do

885-896

Kód UT WoS článku

001246649500001

EID výsledku v databázi Scopus

2-s2.0-85187574086