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Updated: Jun 16, 2025
Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders
Published on: August 18, 2016
Do electrocardiographic changes induced during intracoronary vasospasm provocation testing reflect those during
Rutger G T Feenstra1, Lotte S Timmerman1, Jan J Piek1
1Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Heart Centre, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands.
Insights
Electrocardiogram (ECG) changes during vasospastic angina (VSA) episodes may differ between spontaneous events and acetylcholine-induced spasms. Prompt ECGs during spontaneous angina and early intracoronary testing are crucial for accurate VSA diagnosis.
Area of Science:
- Cardiology
- Clinical Electrophysiology
Background:
- The Coronary Vasomotor Disorders International Study (COVADIS) suggests similar ECG criteria for diagnosing vasospastic angina (VSA) during spontaneous episodes and intracoronary spasm testing.
- A key question remains whether ECG changes induced by acetylcholine during epicardial spasms accurately reflect those during spontaneous VSA episodes.
Background:
According to the Coronary Vasomotor Disorders International Study (COVADIS) group, the ECG criteria supporting the diagnosis of vasospastic angina (VSA) in spontaneous episodes or induced during intracoronary spasm testing are similar. However, it remains elusive whether acetylcholine-induced ECG changes during epicardial spasms reflect ECG changes that occur during the height of a spontaneous episode.
Case Summary:
We present four patients diagnosed with VSA during intracoronary spasm testing, of whom the ECG characteristics during spasm testing and a spontaneous angina episode are described. All patients have >90% coronary epicardial vasoconstriction in one or more vessels during acetylcholine provocation. ECGs at the height of a spontaneous episode and during acetylcholine-induced coronary spasm are found to be different in three out of four patients.
Discussion:
In patients with VSA, the ECG at the height of a spontaneous episode and during acetylcholine-induced coronary artery spasm may differ substantially. In patients with symptoms suspicious of VSA, every effort should be undertaken to obtain ECGs during the height of a spontaneous episode of angina pectoris and there should be a low threshold to perform intracoronary function testing.
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