ArticleJACC. Case reports2026
Transient ST-Segment Elevation During Cryoablation of the Right Inferior Pulmonary Vein in Atrial Fibrillation.
Article in JACC. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCryoballoon ablation is a widely used technique for pulmonary vein isolation in atrial fibrillation. Coronary artery spasm (CAS) is a rare but serious complication during this procedure. CASE SUMMARY: A 73-year-old man with persistent atrial fibrillation underwent cryoablation. During ablation of the right inferior pulmonary vein (RIPV), abrupt ST-segment elevation (2-3 mm in the inferior leads) occurred alongside hypotension and tachycardia. Immediate cessation of cryoenergy resulted in spontaneous resolution of electrocardiographic changes and hemodynamic recovery, consistent with CAS. DISCUSSION: This case suggests that RIPV cryoablation may trigger CAS via direct cryothermal stimulation or autonomic neural reflexes. Pre-existing endothelial dysfunction from hypertension, diabetes, and smoking history likely increased susceptibility. Prophylactic nitroglycerin may not consistently prevent spasms in peripheral venous access. TAKE-HOME MESSAGES: Vigilant real-time electrocardiographic monitoring during RIPV ablation is crucial. Prompt recognition and termination of energy delivery are key to managing this life-threatening complication.
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