Abstract
BACKGROUND: Pulsed field ablation (PFA) is an innovative, nonthermal, and effective method for pulmonary vein isolation, with a favorable safety profile in the treatment of atrial fibrillation (AF). CASE SUMMARY: A 74-year-old woman underwent elective pulmonary vein isolation with PFA for paroxysmal AF under general anesthesia with a laryngeal mask airway. During PFA delivery to the left superior pulmonary vein, a vocal cord spasm occurred, requiring immediate airway intervention. Ventilation was restored with a muscle relaxant followed by endotracheal intubation. DISCUSSION: Although muscle contractions and vasospasms have been documented previously during PFA, this case is the first to be reported of laryngospasm. We hypothesize that it may result from direct stimulation of the recurrent laryngeal or vagus nerve owing to the superior vein course and deep catheter positioning. TAKE-HOME MESSAGE: Because laryngospasm may occur, preparation for acute airway obstruction management is essential during PFA for AF.