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July 3, 2026JACC Case ReportsOpen Access

Acetylcholine provocation under circulatory support confirms severe coronary vasospasm as the cause of refractory VF.

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Population

A previously healthy 36-year-old man presenting with recurrent early-morning chest pain followed by…

Design

Case_report

Key result

Acetylcholine provocation testing under circulatory support confirmed severe coronary vasospasm as the cause of refractory ventricular fibrillation in a patient with moderate fixed coronary stenosis.

Authors

HNHirokazu NishidoSHSatoshi HondaTNTeruo Noguchi

Discussion

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Member takes

Overview

Consider vasospasm in young VF survivors with moderate lesions; case report leaves open routine provocative testing.

Key Points

  • This case aims to illustrate the connection between coronary vasospasm and refractory ventricular fibrillation in the presence of fixed coronary stenosis.
  • A 36-year-old man with chest pain underwent coronary angiography revealing moderate stenosis.
  • Optical coherence tomography was used to evaluate plaque presence and thrombus, showing no rupture.
  • Acetylcholine provocation testing confirmed severe coronary vasospasm under circulatory support.
  • The patient required venoarterial extracorporeal membrane oxygenation due to refractory ventricular fibrillation.
  • Coronary angiography showed functionally significant ischemia despite nonocclusive lesions.
  • Provocation testing confirmed the diagnosis of coronary vasospasm underlying ventricular arrhythmias.

Study Design

Type

Case Report (n=1)

Structured PICO

P
Population
A 36-year-old man with refractory ventricular fibrillation requiring venoarterial extracorporeal membrane oxygenation.
I
Intervention
Acetylcholine provocation testing under circulatory support
O
Outcome
Diagnosis of severe coronary vasospasm

Coronary vasospasm should be considered and evaluated via provocation testing in survivors of malignant ventricular arrhythmias when fixed coronary findings do not fully explain the presentation.

Cite This Study

Nishido et al. (2026) conducted a case report in Refractory ventricular fibrillation (n=1). Acetylcholine provocation testing was evaluated. Acetylcholine provocation testing under circulatory support confirmed severe coronary vasospasm as the cause of refractory ventricular fibrillation in a patient with moderate fixed coronary stenosis.

synapsesocial.com/papers/6a4752ba5c29257aa257948dhttps://doi.org/10.1016/j.jaccas.2026.109104
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