Key result
Coronary stent implantation and implantable cardioverter defibrillators may be considered for focal, refractory coronary vasospasm complicated by lethal ventricular arrhythmias.
Coronary stent implantation may be considered for focal, refractory coronary vasospasm, and ICDs are warranted when complicated by lethal ventricular arrhythmias.
May inform management of refractory vasospasm; leaves open need for prospective trials before practice change.
Coronary vasospasm is an unusual cause of angina and myocardial ischemia, with the potential to provoke acute myocardial infarction, malignant cardiac arrhythmias, and sudden cardiac death. The diagnosis is largely clinical and requires a high index of suspicion. Provocation studies are rarely performed due to the risks of the procedure and the relatively low incidence of disease. A subset of patients does not respond to conventional medical therapy and a paucity of evidence exists to guide therapy. While generally believed a multifocal phenomenon, there have been reports of successful treatment of focal, refractory vasospasm with coronary stent implantation. Furthermore, consideration of an implantable cardioverter defibrillator is warranted when vasospasm is complicated by lethal ventricular arrhythmias.
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Dresen et al. (2012) conducted a review in Coronary vasospasm-induced polymorphic ventricular tachycardia. Coronary stent implantation and implantable cardioverter defibrillator was evaluated. Coronary stent implantation and implantable cardioverter defibrillators may be considered for focal, refractory coronary vasospasm complicated by lethal ventricular arrhythmias.
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