Laryngospasm During Pulsed Field Ablation of the Left Superior Pulmonary Vein

Q4 Medicine

JACC. Case reports Pub Date : 2025-02-05 DOI:10.1016/j.jaccas.2024.103095

Bartosz Żuchowski MD, PhD , Małgorzata Połetek MD, PhD , Mateusz Dziarmaga MD, PhD , Adrianna Jęchorek MSc , Jakub Szrama MD, PhD , Przemysław Guzik MD, PhD , Andrzej Minczykowski MD, PhD , Andrzej Wykrętowicz MD, PhD

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Abstract

Background

Pulsed field ablation (PFA) is an innovative, nonthermal, and effective method for pulmonary vein isolation, with a favorable safety profile in the treatment of atrial fibrillation (AF).

Case Summary

A 74-year-old woman underwent elective pulmonary vein isolation with PFA for paroxysmal AF under general anesthesia with a laryngeal mask airway. During PFA delivery to the left superior pulmonary vein, a vocal cord spasm occurred, requiring immediate airway intervention. Ventilation was restored with a muscle relaxant followed by endotracheal intubation.

Discussion

Although muscle contractions and vasospasms have been documented previously during PFA, this case is the first to be reported of laryngospasm. We hypothesize that it may result from direct stimulation of the recurrent laryngeal or vagus nerve owing to the superior vein course and deep catheter positioning.