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Nonetheless, recent studies 2, 3 have raised concerns about a possible correlation between pulsed electric field applications adjacent to coronary arteries and transient coronary spasm. Severe subtotal right coronary artery (RCA) spasm has been documented recently in all patients undergoing coronary angiography shortly after cavotricuspid isthmus(CTI) PFA. 3 PFA-induced vasospastic events have been described as benign entities, because cardiac arrhythmias or other spasmrelated major adverse events have never been documented.

Herein, we describe the first case of transient inferior ST-segment elevation evolving into cardiac arrest after PFA targeting the CTI. Since April 2022, 6 (5.6%, 83% male, age range 56-70 years) of 108 patients undergoing atrial fibrillation (AF) ablation with the Farapulse technology at our center received additional pulsed-field applications targeting the CTI; transient inferior ST …