Acute STEMI Due to Severe Triple-Vessel Spasm After IV Adenosine Injection During Cryo-Balloon Isolation

Area of Science:

• Cardiology
• Electrophysiology
• Pharmacology

Background:

• Adenosine is frequently administered intravenously following pulmonary vein isolation procedures.
• Its purpose is to assess for dormant electrical conduction, a potential cause of atrial fibrillation recurrence.

Observation:

• A 60-year-old patient developed significant hypotension, conduction abnormalities, and ST-segment elevation.
• These symptoms occurred immediately after a standard adenosine injection during the post-pulmonary vein isolation assessment.

Findings:

• Coronary angiography demonstrated diffuse coronary artery spasm in the patient.
• The spasm was effectively managed and resolved with the administration of intracoronary nitroglycerin.

Implications:

• This case highlights a rare but serious adverse reaction to adenosine, specifically coronary spasm.
• Clinicians should be vigilant for vasospastic complications in patients receiving adenosine, even in the context of electrophysiology procedures.
• Prompt recognition and treatment with vasodilators like nitroglycerin are crucial for managing adenosine-induced coronary spasm.