Cardiac autonomic ganglion ablation for refractory coronary artery spasm after PCI: a case report

A 45-year-old male patient presented with recurrent nocturnal or early morning chest pain following coronary stent implantation, and the electrocardiogram findings were consistent with Wellens' syndrome. Due to a low baseline heart rate, the patient could not tolerate diltiazem, and the response to standard anti-spastic medical therapy was poor. Intracoronary ergonovine provocation testing induced severe spasms of the left anterior descending and left circumflex arteries and reproduced the patient's chest pain. Given the typical presentation of heightened vagal tone, catheter ablation of cardiac autonomic ganglia was performed under the guidance of a three-dimensional electroanatomical mapping system. Post-ablation, repeat ergonovine testing showed markedly attenuated coronary artery spasm that resolved spontaneously, and the patient experienced no chest pain. At the 2-month follow-up, angina had completely resolved. This case suggests that cardiac autonomic ganglion ablation may be a valuable non-pharmacological treatment option for patients with refractory vasospastic angina after PCI who exhibit heightened vagal tone.