Paroxysmal atrial fibrillation during intracoronary acetylcholine provocation test

Saito, Yuichi; Kitahara, Hideki; Shoji, Toshihiro; Tokimasa, Satoshi; Nakayama, Takashi; Sugimoto, Kazumasa; Fujimoto, Yoshihide; Kobayashi, Yoshio

doi:10.1007/s00380-016-0939-2

Cited by 14 publications

(5 citation statements)

References 32 publications

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“…Thus, it is safe to conclude that the SPT can be performed from either the LCA or RCA. Saito et al reported that Af is more likely to occur when the SPT is started from the RCA [29]. In this study, Af also occurred more frequently during RCA provocation in the group wherein the SPT was initiated from the RCA.…”

Section: Discussionsupporting

confidence: 48%

“…Carefully performing SPT is necessary in the future. The rate of paroxysmal Af has been reported to be 8-17% [28,29], which may be influenced by whether the LCA or RCA is being provocative and by what provocation dose is being applied. Our data may have a higher frequency of Af; however, they do not seem to deviate from the conventional direction.…”

Section: Discussionmentioning

confidence: 99%

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Which Coronary Artery Should Be Preferred for Starting the Coronary Spasm Provocation Test?

Teragawa,

Uchimura,

Oshita

et al. 2023

Life

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Background: The spasm provocation test (SPT) is a critical test for diagnosing vasospastic angina (VSA). However, the choice of vessel to be preferred for initiating the SPT—the right coronary artery (RCA) or the left coronary artery (LCA)—is unclear. This study aimed to assess SPT results including SPT-related complications while initiating the SPT in the RCA and LCA. Methods: We enrolled 225 patients who underwent coronary angiography and SPTs. The SPT was first performed in the RCA in 133 patients (RCA group) and the LCA in 92 patients (LCA group). We defined VSA as >90% narrowing of the coronary artery during the SPT, accompanied by chest pain and/or ST–T changes on the electrocardiogram. When coronary spasm occurs in two or more major coronary arteries, it is referred to as a multivessel spasm (MVS). SPT-related complications comprised atrial fibrillation, ventricular fibrillation, and unstable hemodynamics following catecholamine use. Analyses using propensity score matching (PSM) were performed in 120 patients. Results: No significant differences in the frequencies of VSA and complications were observed between the two groups (RCA: 79% and 19%, respectively; LCA: 85% and 22%, respectively). In both groups, spasms were most frequently provoked in the left anterior descending coronary artery (both p < 0.001) whereas spasms in the left circumflex coronary artery (LCX) were higher in the LCA group than in the RCA group (p = 0.015). Furthermore, no significant difference in the frequency of MVS was observed between both groups (RCA: 50%, LCA: 62%; p = 0.122). After PSM, no significant difference in the frequencies of VSA and complications were observed between the two groups (RCA: 82% and 15%, respectively; LCA: 88% and 18%, respectively). The frequencies of LCX spasms (RCA: 8%, LCA: 23%; p = 0.022) and MVS (RCA: 40%, LCA: 62%; p = 0.020) were higher in the LCA group than in the RCA group. Conclusions: Although the diagnostic rate of VSA and frequency of SPT-related complications were similar in the two groups, the frequency of MVS was higher in the LCA group than in the RCA group because of the increase in the number of LCX spasms. A routine SPT may be started from the LCA.

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Section: Discussionsupporting

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Which Coronary Artery Should Be Preferred for Starting the Coronary Spasm Provocation Test?

Teragawa,

Uchimura,

Oshita

et al. 2023

Life

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“…We advocate proceeding without transvenous pacing and applying caution with testing the right coronary or left-dominant circulations. Self-limiting atrial fibrillation is also common (8%), particularly during evaluation of right coronary vascular function ( 90 ). Patients undergoing clinically indicated coronary angiography typically have risk factors for cardiovascular disease, including atrial fibrillation.…”

Section: How To Assess Coronary Vascular Dysfunction In the Catheterimentioning

confidence: 99%

Assessment of Vascular Dysfunction in Patients Without Obstructive Coronary Artery Disease

Ford

Ong

Sechtem

et al. 2020

JACC: Cardiovascular Interventions

128

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Ischemic heart disease secondary to coronary vascular dysfunction causes angina and impairs quality of life and prognosis. About one-half of patients with symptoms and signs of ischemia turn out not to have obstructive coronary artery disease, and coronary vascular dysfunction may be relevant. Adjunctive tests of coronary vasomotion include guidewire-based techniques with adenosine and reactivity testing, typically by intracoronary infusion of acetylcholine. The CorMicA (Coronary Microvascular Angina) trial provided evidence that routine management guided by an interventional diagnostic procedure and stratified therapy improves angina and quality of life in patients with angina but no obstructive coronary artery disease. In this paper, the COVADIS study group provide a comprehensive review of why, how, and when coronary vascular dysfunction should be assessed invasively. They discuss the rationale through a shared understanding of vascular pathophysiology and clinical evidence. They propose a consensus approach to how an interventional diagnostic procedure is performed with focus on practical aspects. Finally, the authors discuss the clinical scenarios in patients with stable and acute coronary syndromes in which measurement of coronary vascular function may be helpful for patient care.

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“…[1–5] During the ACh test, paroxysmal atrial fibrillation (PAF) is frequently (8.0-22.8%) provoked, is usually transient, and sometimes requires treatment with antiarrhythmic drugs or electrical cardioversion. [6–10] Although PAF during the ACh test is generally recognized as a minor complication, it may have clinical implications.…”

Section: Introductionmentioning

confidence: 99%

Clinical Implications of Atrial Fibrillation Provoked by Acetylcholine

Shibata,

Wakabayashi,

Ikeda

et al. 2023

Preprint

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Background: The coronary spasm provocation test using acetylcholine (ACh) is useful for diagnosing vasospastic angina (VSA). Paroxysmal atrial fibrillation (PAF) during ACh testing is frequent and usually transient. However, the clinical implications of PAF provoked by ACh is unknown. Deterioration of the left atrial (LA) reservoir strain is associated with new-onset of atrial fibrillation (AF) and fibrosis of the left atrium; additionally, ACh shortens the action potential duration and facilitates AF in the fibrotic atria in the human AF model. Hence, this study aimed to investigate the relationship between LA function and occurrence of AF during the ACh test. Methods: We studied a consecutive cohort of 100 patients (60.1±14.5 years, 39 women) without history of AF who underwent the ACh test in our centers from 2015 to 2022. Echocardiographic data were available for all the patients. PAF was defined as lasting >30 s during the ACh test. Based on the occurrence of AF during the ACh test, the patients were divided into two groups: provoked PAF group (n=29) vs. non AF group (n=71). LA function was assessed via two-dimensional speckle-tracking echocardiography. Occurrences of spontaneous AF were recorded as clinical events during long-term follow-up. Results: The observation period was 675 (114.5-1789.5) days, and 65 patients (65%) were tested positive in the ACh test and diagnosed with VSA. LA volume index was similar between provoked PAF and non AF groups (26.9±7.4 mL/m2 vs. 27.1±8.5 mL/m2, p=0.89). In contrast, LA reservoir (27.6±5.2% vs. 34.8±6.8%, p<0.001) and conduit (13.4±5.1% vs. 18.4±6.2%, p<0.001) strain were significantly lower in provoked PAF group than in non AF group. The provoked PAF group had a lower LA booster strain (14.1±5.6% vs. 16.4±6.3%, p=0.093) than non AF group. A multiple regression analysis showed that LA reservoir strain was independently associated with the provoked PAF during ACh test (OR 0.81, 95% CI: 0.72-0.91, p<0.001). In the provoked PAF group, spontaneous AF occurred in three patients (10.3%), one of whom was treated with pulmonary vein isolation, whereas there were no events of PAF in the non AF group. Conclusion: The occurrence of PAF during the ACh test suggests dysfunction of left atria and may predict future PAF.

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Paroxysmal atrial fibrillation during intracoronary acetylcholine provocation test

Cited by 14 publications

References 32 publications

Which Coronary Artery Should Be Preferred for Starting the Coronary Spasm Provocation Test?

Which Coronary Artery Should Be Preferred for Starting the Coronary Spasm Provocation Test?

Assessment of Vascular Dysfunction in Patients Without Obstructive Coronary Artery Disease

Clinical Implications of Atrial Fibrillation Provoked by Acetylcholine

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