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The Relationship between Paroxysmal Atrial Fibrillation and Coronary Artery Spasm
Author(s) -
KAWAKAMI TOHRU,
OHNO HIROYOSHI,
TANAKA NOBUKIYO,
ISHIHARA HIROKI,
KOBAYAKAWA HIROKO,
SAKURAI TOMOHIRO
Publication year - 2014
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12299
Subject(s) - medicine , cardiology , artery , atrial fibrillation , provocation test , catheter ablation , ergonovine , coronary vasospasm , anesthesia , myocardial infarction , angina , alternative medicine , pathology
Background Coronary artery spasm has recently been reported as a complication of the ablation of atrial fibrillation (AF). It may be induced by cardiac autonomic nervous dysfunction during radiofrequency catheter ablation of AF. However, the underlying mechanism is not clear. We hypothesized that patients with paroxysmal AF coincidentally exhibit coronary artery spasm. Methods A total of 51 patients were enrolled in a case control study to clarify the relationship between paroxysmal AF and coronary artery spasm. We evaluated 17 patients with paroxysmal AF (AF group) and 34 patients without paroxysmal AF (control group). Drug‐induced coronary artery spasm provocation tests were performed by intracoronary administration of acetylcholine or ergonovine. Results The AF group consisted of nine males and eight females, mean age 67 ± 10 years. The control group consisted of 16 males and 18 females, mean age 60 ± 14 years. In the AF group, coronary artery spasm was induced in 13 patients (76.5%) before AF ablation. In the control group, coronary artery spasm was induced in three patients (8.8%). Coronary artery spasm was more frequently induced in patients with AF (76.5% vs 8.8%; odds ratio, 33.583; 95% confidence interval, 6.5732–171.58; P < 0.0001). In the AF group, ventricular fibrillation and AF were recorded immediately after right coronary artery spasm induction in one patient. Conclusions Paroxysmal AF patients have high positive rates of drug‐provoked coronary artery spasm. Patients with paroxysmal AF may coincidentally exhibit coronary artery spasm