Key result
Bilateral thoracic sympathectomy halts recurrent fatal arrhythmias at 6 months in refractory vasospastic angina.
Why the study?
Coronary artery vasospasm can cause fatal arrhythmias and sudden death and may be refractory to optimal medical treatment, requiring more aggressive interventions.
Case Report (n=1)
No
Sympathectomy and ICD implantation may be effective last-resort treatments for patients with refractory coronary artery vasospasm and malignant arrhythmias.
May support sympathectomy as last-resort option in refractory vasospasm; hypothesis-generating and requires validation before practice change.
Coronary artery vasospasm (CAVS) is a clinical entity that can cause angina, but also unstable angina pectoris, acute myocardial infarction, fatal arrhythmias, and sudden death. Although it is a condition that is usually controlled with medical treatment, more aggressive treatments may rarely be required. In this case, the patient with a known diagnosis of CAVS had multiple arrests despite optimal medical treatment. We observed that fatal arrhythmias persisted in the Implantable Cardioverter Defibrillator (ICD) records, even though we implanted a stent and gave the patient maximal medical treatment. We performed sympathectomy as a last resort and we did not detect any recurrence in the 6-month follow-up of the patient. ICD implantation and sympathectomy should always be considered in resistant CAVS cases.
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Doğan et al. (2023) conducted a case report in Refractory Coronary Artery Vasospasm (n=1). Surgical sympathectomy, ICD implantation, and PCI was evaluated on Recurrence of angina, ventricular arrhythmias, or cardiac arrest. Bilateral thoracic sympathectomy prevented any recurrence of symptoms or arrhythmias over a 6-month follow-up in a patient with refractory coronary artery vasospasm and recurrent cardiac arrests.
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