Sequential Spasm Provocation Tests under Medications Are Indispensable in Patients with Aborted Sudden Cardiac Death due to Coronary Spasm

The Authors Reply We appreciate your letter. In previous reports, a majority of cardiologists around the world have recommended implantable cardioverter-defibrillator (ICD) therapy for patients with aborted sudden cardiac death (ASCD) due to coronary spasm positively. Ahn et al. also recommended ICD implantation in patients with ASCD due to coronary spasm. Of the 24 ASCD patients who received ICDs in their study, 6 experienced ventricular fibrillation; 5 of these patients received appropriate treatment, but 1 died due to intractable ventricular fibrillation (1). Appropriate ICD shocks in their study patients were recognized in a quarter of patients who received ICDs, while the remaining three-quarters had no appropriate ICD shocks during followup periods. The frequency of appropriate ICD shocks was similar to that in our previous reports [24.1% (33/137)] (2). Furthermore, the medications aside from nicorandil administered to patients were not markedly different between patients with and without ASCD due to coronary spasm, according to Ahn et al. Thus, the number of calcium channel blockers (CCBs) administered was similar between the two groups.