Clinical characteristics and possible mechanism of paroxysmal atrial fibrillation induced by intracoronary injection of acetylcholine

We recently reported on the frequency of provoked coronary artery spasm wit h intracoronary injection of acetycholine (ACh) and the major complications of ACh testing in Japanese patients.(1,2) Multicenter studies have address ed the fact that not only chronic atrial fibrillation (AF), but also paroxy smal AF could predispose patients to systemic embolism.(3-7) According to C oumel,(8) disorders of autonomic nervous balance seem to play a major role of occurrence of paroxysmal AF. Paroxysmal AF often occurred during spasm p rovocation tests of ACh. However, clinical investigation of ACh-induced par oxysmal AF in detail has not been reported. Moreover, no data exist concern ing the correlation between paroxysmal AF during daily life and ACh-induced paroxysmal AF. In this study, we sought to clarify the clinical characteri stics and possible mechanism of ACh-induced paroxysmal AF in patients with coronary arteriography and spasm provocation tests of ACh.