Tongji Hospital Pioneers World's First GP Ablation for Variant Angina

Background

Variant angina, also known as vasospastic angina, causes chest pain due to temporary spasms in the coronary arteries rather than permanent narrowing from atherosclerosis. These episodes often occur at rest or during the night and can lead to severe symptoms including ST-segment changes on ECG. Traditional treatment relies on medications such as calcium channel blockers and nitrates to prevent spasms, but some patients continue to experience refractory symptoms despite optimal drug therapy. The cardiovascular team recognized the potential role of heightened vagal nerve activity in triggering these coronary spasms.

What was achieved

In September 2025, the team completed the world's first GP (cardiac vagal ganglion or ganglionated plexus) ablation for variant angina. The case was reported in the European Heart Journal - Case Reports. For one patient from Heilongjiang province, who had traveled more than 2,000 kilometers seeking care, symptoms that had persisted despite medication were significantly relieved following the procedure. The team has initiated an international randomized controlled trial. Preliminary results from treated patients show approximately 80 percent remained free of recurrence after stopping medication. The results have been presented internationally, with the team invited to demonstrate the surgery.

How it works

Coronary artery spasm in variant angina can be linked to excessive parasympathetic signals from the vagus nerve. Rather than intervening directly on the blood vessels, the GP ablation procedure uses a catheter inserted into the heart to target and disrupt specific nerve clusters known as ganglionated plexi (GPs), which act as relay stations for autonomic control of the heart and coronary arteries. The procedure employs three-dimensional electroanatomic mapping to locate the main GPs, typically four or five key sites in the left atrium. Radiofrequency energy is then applied to ablate these ganglia, reducing vagal tone.

To verify effect, doctors perform an ergonovine provocation test during the procedure: this chemical induces spasm for observation. In the reported case, the right coronary artery occluded rapidly, causing chest pain and brief cardiac arrest requiring pacing and nitroglycerin. After ablating the GPs, a repeat test with the same dose showed markedly reduced spasm severity; the nitroglycerin dose required dropped from 800 micrograms to 200 micrograms. Follow-up indicated resolution of nocturnal chest pain without antispasmodic medications in the reported cases.

What it means for international patients

This neural modulation approach offers an alternative for individuals with drug-refractory variant angina by targeting the underlying autonomic imbalance instead of the vessel wall. Tongji Hospital maintains an International Medical Department, designated by provincial authorities as the primary facility for foreign patients, overseas Chinese, and VIP care. The department has served patients from 44 countries and regions with dedicated facilities, translation services, multidisciplinary consultations, and advanced equipment. Patients interested in GP ablation or the ongoing randomized trial must confirm eligibility, current availability, and suitability directly with the hospital, as individual cases require thorough evaluation by the cardiovascular specialists.

About the hospital

Tongji Hospital, also known as Tongji Hospital of Tongji Medical College at Huazhong University of Science and Technology, is a major Grade A tertiary hospital in Wuhan, China. Its cardiovascular department was founded in 1959 and has extensive experience in complex interventional cardiology and electrophysiology, including zero-fluoroscopy radiofrequency ablation and pacemaker implantation. The department has 301 beds, sees over 230,000 outpatients annually and performs over 34,000 interventional procedures per year. It is recognized as a Ministry of Education key discipline and national clinical key specialty.

The hospital was the first in Hubei selected to treat foreign patients and international dignitaries. Its International Medical Department, established in 2012, provides comprehensive services including outpatient, inpatient, and health management for international visitors, with access to specialists across more than 40 departments. It maintains partnerships with international insurers. In Fudan University hospital evaluations, its cardiology service has ranked 15th nationally.