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A 50-year-old nonsmoker with paroxysmal atrial fibrillation was referred to our hospital for pulmonary vein isolation (PVI). He had a known 1-vessel coronary artery disease. Because of stable angina, a drug-eluting stent had been implanted into the midportion of the left anterior descending artery in 2010. Otherwise he was healthy. His medical treatment included warfarin, sotalol, an angiotensin-converting enzyme-inhibitor and a statin. Cryoballoon-PVI (Arctic Front Advance 28 mm; Medtronic) was scheduled under general anesthesia (international normalized ratio, 2–9; minimal activated clotting time, 300 s). After transseptal access, the left PV were targeted first, followed by the right inferior PV and right superior PV, respectively. PVI of all PVs could be visualized in real-time and gained within 40 s. Two freeze–thaw cycles were used for each PV, except for the left superior PV, which had to be treated 3×, because of an initially ineffective freeze (Table I in the Data Supplement). The procedure had been uneventful, until a sudden blood pressure drop occurred (70/40 mm Hg), …

Near-Fatal Coronary Artery Spasm During Cryoballoon Pulmonary Vein Isolation