Among patients with vasospastic angina and lethal ventricular arrhythmia, recurrent ventricular fibrillation or pulseless electrical activity occurred in 21.7% over a median 2.1 years.
Observational (n=23)
Yes
Does an implantable cardioverter-defibrillator (ICD) prevent death in patients with vasospastic angina and lethal ventricular arrhythmia?
In patients with vasospastic angina and prior lethal ventricular arrhythmia, ICD implantation is appropriate due to a high recurrence rate (21.7%) of life-threatening arrhythmias.
OBJECTIVES: The present study was performed to investigate the clinical implications of an implantable cardioverter-defibrillator (ICD) in patients with vasospastic angina (VSA) resuscitated from lethal ventricular arrhythmia. BACKGROUND: The prognosis of VSA is known to be good with medication; however, ventricular arrhythmia and cardiopulmonary arrest are rare but life-threatening complications of this disease. The ICD is a proven modality for patients with ventricular arrhythmia, but the clinical implications in this population remain to be elucidated. METHODS: We conducted a retrospective, observational, multicenter study involving patients with an ICD due to documented ventricular arrhythmia and VSA diagnosed by acetylcholine provocation test. All patients were followed up for appropriate ICD therapy, sudden cardiac arrest, or death from all causes. RESULTS: Twenty-three patients were included in the present study and completely followed up. All patients are still alive. During a follow-up of 2.9 years (median 2.1 years), 4 ventricular fibrillations and 1 episode of pulseless electrical activity occurred in 5 patients (21.7%). There were no statistically significant differences in patient characteristics between the recurrence and nonrecurrence groups, including medication, smoking status, and whether the patient was or was not free of symptoms after ICD implantation. CONCLUSIONS: Patients with VSA and lethal ventricular arrhythmia are a population at high risk for recurrence of cardiopulmonary arrest, and there is no reliable indicator for predicting recurrence of ventricular arrhythmia. Insertion of an ICD with medication for VSA is appropriate for this high-risk population.
“The current guidelines are silent with respect to use of an ICD in patients with coronary artery vasospasm. Although the results of the report of Matsue et al. support the use of ICD therapy in patients with coronary artery vasospasm who have survived an episode of life-threatening VT/VF.”
Matsue et al. (Wed,) conducted a observational in Vasospastic angina (VSA) resuscitated from lethal ventricular arrhythmia (n=23). Implantable cardioverter-defibrillator (ICD) was evaluated on Appropriate ICD therapy, sudden cardiac arrest, or death from all causes. Among patients with vasospastic angina and lethal ventricular arrhythmia, recurrent ventricular fibrillation or pulseless electrical activity occurred in 21.7% over a median 2.1 years.