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2026 AF Symposium
Best Abstract Award for “Complication of Pulsed Field Ablation: Coronary Artery Spasm” by Dr. Devi Nair
AF Symposium Abstracts are concise summaries of research, presented as “posters” and posted on panels in a long hallway. At this year’s Symposium there were 103 abstracts with a wealth of the latest information. The panels stretched as far as the eye could see (see photo). (Last year there were 60+ abstracts.)
Steve Ryan and Dr. Devi Nair
Best Abstract Award to Dr. Devi Nair
A major event at the end of the Friday session was the Best Abstract Award presentation to Dr. Devi Nair, MD, FACC, FHRS for her abstract, Complication of Pulsed Field Ablation: Coronary Artery Spasm, an unusual and noteworthy topic. [Reference: AF Symposium Program p.23, AFS2026-06, Submission # 2296389]
Dr. Nair is Director of Cardiac Electrophysiology, St. Bernard’s Heart & Vascular Center, Jonesboro, AR, and was one of the major faculty contributors to the 2026 AF Symposium. She was a faculty presenter/panel member in nine different sessions. AF Symposium Director Dr. Moussa Mansour gave her a great shout-out to thank her for her contributions.
Abstract: Complication of Pulsed Field Ablation: Coronary Artery Spasm
Coronary artery spasm has emerged as a novel but significant complication of Pulsed Field Ablation (PFA) [reported complication incidence is 0.08% to 0.14%]. It is proximity related.
If focal PFA energy is delivered next to arteries, it can send an artery into spasm causing severe damage, even death. This can be avoided by ablating away from coronary vessels or by pre-treating patients with nitroglycerine (NTC).
Dr. Nair’s Marshall Islander Patients More Susceptible
When the atomic bomb was tested by the U.S. in the Marshall Islands from 1946–1958, it caused massive environmental destruction and resulted in long-term health issues for the Marshallese people.
Marchallese immigration to the U.S. increased with the 1986 Compact of Free Association (COFA) which allows Marshallese to live and work in the U.S. without visas.
Ultimately, many Marchallese residents relocated to Arkansas, seeking jobs in the poultry industry.
Dr. Nair’s practice is located in Arkansas and many of her patients are from the Marshall Islands.
PFA and Generalized Coronary Spasm (Gen-CS)
After undergoing a Pulsed Field Ablation (PFA), five of Dr. Nair’s A-Fib patients suffered from Generalized Coronary Spasm (Gen-CS). For such a rare disease, five cases is a very high concentration.
Muscle spasms (cramps) are sudden, involuntary, often painful contractions. In typical coronary spasm, PFA has to be delivered near or touching a coronary artery to produce spasm.
Generalized Coronary Spasm (Gen-CS), is more common in people in the geocultural region of East Asia (China, Japan, South Korea, North Korea, Mongolia, and Taiwan,).
But Gen-CS is a diffuse, multi-vessel, clinically destabilizing form of spasm which can occur despite ablation away from coronaries.
Dr. Nair and her colleagues concluded that Generalized Coronary Spasm was unexpectedly common in this Marshallese population undergoing PFA. In their experience, GCS didn’t occur with thermal RF ablation. This raises the possibility that PFA is generally more likely to induce Gen-CS than thermal ablation.
Editor’s Comments
Editor’s CommentsI was aware of Coronary Artery Spasm as a novel but significant complication of Pulsed Field Ablation (PFA). But Dr. Nair’s abstract on the Marshallese susceptibility to spasm (Gen-CS) was an eye-opener for me. I found it fascinating to read.
