Cardioneuroablation for coronary artery vasospasm: a case report.

Background: Coronary artery spasm (CAS) occurring at night may be caused by excessive vagal tone. In patients with CAS related to high vagal tone, cardioneuroablation (CNA) may offer a promising alternative for the radical treatment of medication-refractory CAS.

Case summary: We report a case of a 66-year-old male with frequent and uncontrolled coronary artery spasms, usually occurring during sleep at night. Despite treatment with multiple antispasmodic medications including calcium channel blockers and long-acting nitrates, the patient still experienced severe symptomatic chest pain with ST-segment elevation. Ergonovine challenge testing confirmed the diagnosis of CAS with multiple spasms in the right coronary artery. Cardioneuroablation targeting four main ganglionated plexi on the left atrium was performed, resulting in complete resolution of nocturnal angina pectoris for six-month follow-up without antispasmodic medications. Post-ablation autonomic parameters showed decreased parasympathetic tone, and repeat ergonovine challenge demonstrated reduced vasomotor response.

Discussion: This case provides preliminary evidence for the potential of CNA in treating refractory CAS by modulating autonomic tone. Cardioneuroablation may provide a novel alternative for patients whose CAS is unresponsive to conventional medical therapy, though larger studies with longer follow-up are needed to validate this approach's efficacy and safety.