Importance In treating atrial fibrillation, pulsed field ablation (PFA) is a novel energy modality with comparable efficacy to conventional thermal ablation, such as radiofrequency ablation (RFA), but with the benefit of some preferentiality to myocardial tissue ablation. Studies have demonstrated important safety advantages, including the absence of esophageal injury or pulmonary vein stenosis and only rare phrenic nerve injury. However, there is emerging evidence of coronary artery vasospasm provoked by PFA. Objective To compare the incidence and severity of left circumflex arterial vasospasm between PFA and RFA during adjacent ablation along the mitral isthmus. Design, Setting, and Participants This prospective cohort study enrolled consecutive adult patients receiving first-ever PFA or RFA of the mitral isthmus during catheter ablation of atrial fibrillation in 2022 with acute follow-up at a single referral European center. Exposure A posterolateral mitral isthmus line was created using either a multielectrode pentaspline PFA catheter (endocardial ablation) or a saline-irrigated RFA catheter. Simultaneous diagnostic coronary angiography was performed before, during, and after catheter ablation. Nitroglycerin was planned for spasm persisting beyond 20 minutes or for significant electrocardiographic changes. Main Outcomes and Measures The frequency and severity of left circumflex arterial vasospasm was assessed and monitored, as were time to remission and any need for nitroglycerin administration. Results Of 26 included patients, 19 (73%) were male, and the mean (SD) age was 65.5 (9.3) years. Patients underwent either PFA (n = 17) or RFA (n = 9) along the mitral isthmus. Coronary spasm was observed in 7 of 17 patients (41.2%) undergoing PFA: in 7 of 9 (77.8%) when the mitral isthmus ablation line was situated superiorly and in 0 of 8 when situated inferiorly. Conversely, coronary spasm did not occur in any of the 9 patients undergoing RFA. Of 5 patients in whom crossover PFA was performed after RFA failed to achieve conduction block, coronary spasm occurred in 3 (60%). Most instances of spasm (9 of 10 [90%]) were subclinical, with 2 (20%) requiring nitroglycerin administration. The median (range) time to resolution of spasm was 5 (5-25) minutes. Conclusion and Relevance When creating a mitral isthmus ablation line during catheter ablation of atrial fibrillation, adjacent left circumflex arterial vasospasm frequently occurred with PFA and not RFA but was typically subclinical.

中文翻译：

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脉冲场与二尖瓣峡部射频导管消融期间的冠状动脉痉挛。

重要性 在治疗心房颤动时，脉冲场消融 (PFA) 是一种新型能量方式，其疗效与射频消融 (RFA) 等传统热消融相当，但具有比心肌组织消融更优先的优点。研究已经证明了重要的安全优势，包括不存在食管损伤或肺静脉狭窄以及仅罕见的膈神经损伤。然而，有新的证据表明 PFA 会引起冠状动脉血管痉挛。目的比较二尖瓣峡部邻近消融术中PFA与RFA左回旋动脉血管痉挛的发生率和严重程度。设计、设置和参与者 这项前瞻性队列研究连续纳入了 2022 年在房颤导管消融期间接受首次二尖瓣峡部 PFA 或 RFA 的成年患者，并在单一转诊欧洲中心进行急性随访。暴露 使用多电极五针 PFA 导管（心内膜消融）或盐水冲洗 RFA 导管创建后外侧二尖瓣峡部线。在导管消融之前、期间和之后进行同步诊断性冠状动脉造影。硝酸甘油用于治疗持续超过 20 分钟的痉挛或显着的心电图变化。主要结果和措施评估和监测左回旋动脉血管痉挛的频率和严重程度，以及缓解时间和是否需要给予硝酸甘油。结果 26 名患者中，19 名（73%）为男性，平均（SD）年龄为 65.5（9.3）岁。患者沿二尖瓣峡部接受 PFA (n = 17) 或 RFA (n = 9)。接受 PFA 的 17 名患者中有 7 名 (41.2%) 观察到冠状动脉痉挛：当二尖瓣峡部消融线位于上方时，9 名患者中有 7 名 (77.8%) 出现冠状动脉痉挛；当二尖瓣峡部消融线位于下方时，8 名患者中有 0 名出现冠状动脉痉挛。相反，接受 RFA 的 9 名患者均未出现冠状动脉痉挛。RFA 未能实现传导阻滞后进行交叉 PFA 的 5 例患者中，3 例（60%）发生冠状动脉痉挛。大多数痉挛病例（10 例中有 9 例 [90%]）是亚临床的，其中 2 例（20%）需要给予硝酸甘油。痉挛缓解的中位（范围）时间为 5 (5-25) 分钟。结论和相关性 在房颤导管消融过程中创建二尖瓣峡部消融线时，PFA（而非 RFA）经常发生邻近左回旋动脉血管痉挛，但通常是亚临床的。