[4] and ours may account for the fact that in their series only the sinus node artery was analyzed, while in our study we evaluated the largest atrial branch arising from the right coronary artery, independently of whether this website or not this was the sinus node artery. The mechanism by which atrial branches may be occluded during PTCA is not well known. However, if we extrapolate the information derived from studies on SBO [21], [22] and [23], possible causal mechanisms of ABO could be persistent coronary spasm or the displacement of the atherosclerotic plaque. Coronary vasospasm of the

atrial branch cannot be ruled out in our study because a second testing angiography was not further performed. However, our data reinforce the notion that displacement of an atherosclerotic plaque may be a plausible mechanism. Indeed, we have observed that ABO occurred more learn more frequently in patients with bifurcations lesions with ostial AB atherosclerosis and when higher maximal inflation pressure during stenting is applied. These findings are in agreement

with the predictors reported previously in patients with SBO after PTCA such as the baseline reference diameter of SB and the presence of significant stenosis at the origin of the SB [1], [2], [3] and [21]. Due to the retrospective design, this study can be exposed to patient selection bias. However, the included patients were consecutive and were admitted to the hospital during a well defined 2-years period of time. The lack of a second coronariography after the index PTCA does not allow to exclude that ABO was indeed caused by a transient atrial

coronary spasm. However, a second testing angiography is not indicated since at present time there are no clinical guidelines for ABO. Finally, the large variety of the stent types implanted during this study does not allow to demonstrate any possible association between a particular stent model and the occurrence of ABO. The clinical consequences of acute occlusion of atrial arteries after PTCA have not been prospectively analyzed. However, there are several case-report studies showing that patients with ABO may develop atrial myocardial Edoxaban infarction, sinus node dysfunction and atrial fibrillation [4], [5], [11], [19] and [20]. The close association between the latter arrhythmia and atrial myocardial ischemia was demonstrated in an experimental study in situ dog hearts [24] where the electrophysiological effects of acute ligation of one atrial artery were assessed by epicardial mapping of local electrograms and continuous ECG loop recordings [25]. These studies have demonstrated that acute atrial ischemia creates a substrate capable to elicit and maintain atrial fibrillation. Our study reveals that the incidence of accidental ABO is relatively high and the consequences in terms of atrial arrhythmogenesis are expected to be of clinical relevance.