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Updated: Jul 16, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left atrial catheter ablation promotes vasoconstriction of the right coronary artery
Eiji Yamashita1, Hiroshi Tada, Kazuyoshi Tadokoro
1Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan.
Insights
Left atrial catheter ablation for atrial fibrillation can cause vasoconstriction in the right coronary artery. This finding may explain the occurrence of variant angina after the procedure.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Electrophysiology
Background:
- Left atrial (LA) autonomic ganglia influence cardiac function.
- Catheter ablation (CA) for atrial fibrillation (AF) can alter autonomic activity.
- Vasospastic angina has been reported post-left atrial catheter ablation (LACA).
Purpose of the Study:
- To investigate the impact of LACA on coronary artery tone.
- To determine if LACA affects the right coronary artery (RCA) differently than left coronary arteries.
- To explore the potential link between LACA-induced coronary changes and variant angina.
Main Methods:
- Studied 20 patients with drug-refractory AF undergoing LACA.
- Performed quantitative coronary angiography before and after LACA.
- Analyzed minimal lesion diameter (MLD) and basal tone of coronary arteries.
Main Results:
- No significant changes in left coronary arteries' MLD or basal tone post-LACA.
- Significant decrease in RCA MLD (P < 0.01) and increase in basal tone (P < 0.05) after LACA.
- Increased prevalence of RCA vasoconstriction (75%) compared to left coronary arteries (38%) post-LACA.
Conclusions:
- LACA promotes vasoconstriction in the RCA.
- This RCA vasoconstriction may underlie the development of variant angina after LACA.
- Further research is needed to confirm this association and its clinical implications.
Background:
Multiple cardiac ganglia are present in the left atrial (LA) region, and marked changes in autonomic nervous activity can occur after left atrial catheter ablation (CA) for atrial fibrillation (AF). Vasospastic angina involving the inferior wall of the left ventricle has been reported as a complication shortly after LACA.
Methods:
We studied 20 patients with drug-refractory AF who underwent LACA, performed to encircle the left- and right-sided pulmonary veins, 1 to 2 cm from their ostia under fluoroscopic guidance. Quantitative coronary angiography was performed before and after LACA, and we analyzed the minimal lesion diameter (MLD) of the proximal segment of the coronary arteries, and the basal tone, the baseline percent constriction versus maximal dilation after nitroglycerin administration.
Results:
No significant difference was observed in MLD or basal tone of the left coronary arteries after LACA. However, in the right coronary artery (RCA), the basal MLD was smaller (P < 0.01) and the basal tone was greater (P < 0.05) after than before LACA. No correlation was found between the baseline MLD or tone of the RCA and total amount of radiofrequency energy delivered or procedure duration. In 75% of RCA, the baseline MLD was smaller after than before LACA, which was significantly higher (P < 0.01) than observed in the left coronary arteries (38%).
Conclusion:
Vasoconstriction was promoted in the RCA shortly after LACA, which may explain the variant angina reported after LACA.
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