Life-Threatening Ventricular Arrhythmias in Patients with Silent Myocardial Ischemia Due to Coronary Artery Spasm

Myerburg, Robert J.; Kessler, Kenneth M.; Mallon, Stephen; Cox, Malcolm; DeMarchena, Eduardo; Interian, Alberto; Castellanos, Agustín

doi:10.1056/nejm199205283262202

Cited by 356 publications

(222 citation statements)

References 40 publications

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“…The diagnosis of organic heart disease was made by physical examination, laboratory tests, 12-lead ECG, chest x-ray, 2-dimensional and color-flow Doppler echocardiography, left ventriculography, and coronary angiography. In the present study, all the patients fulfilled the following criteria, defined by Myerburg et al, 4 including (1) documented VF or sustained rapid ventricular tachycardia (VT), (2) absence of a previous history of heart diseases, (3) normal left ventricular ejection fraction and no wall motion abnormality, (4) absence of significant coronary artery stenosis (American Heart Association/American College of Cardiology classification ≥75%), and (5) absence of identifiable or reversible cause of lethal VAs (eg, electrolyte disturbances, metabolic disturbances, and intoxications/drugs). Because they had fully recovered without neurological sequelae, all of them were able to achieve full rehabilitation after discharge.…”

Section: Study Populationmentioning

confidence: 93%

“…20 Although organic heart disease (eg, acute myocardial infarction) is a major cause of OHCA, lethal VAs could occur in patients without organic heart disease, 21 and both CAS and lethal VAs have been considered as major causes of the catastrophe. [4][5][6] We have previously demonstrated the heterogeneity in the pathogenesis of OHCA without organic heart disease and the importance of the dual induction tests for both CAS and VF. 7 Indeed, in the present study, we were able to identify all the 4 groups among OHCA survivors by the dual induction tests.…”

Section: Heterogeneity In the Pathogenesis Of Ohca Without Organic Hementioning

confidence: 99%

“…3 Among the possible functional causes of OHCA, coronary artery spasm (CAS) and lethal ventricular arrhythmias (VAs), such as Brugada syndrome, long QT syndromes (LQTS), and idiopathic ventricular fibrillation (VF), are major causes of the catastrophe. [4][5][6] Furthermore, we have recently demonstrated that patients surviving OHCA without organic heart disease are heterogeneous in the pathogenesis of OHCA, suggesting the importance of identification of the presence or absence of those functional disorders by dual induction tests. 7 The implantable cardioverter-defibrillator (ICD) has become an established device for secondary prevention of sudden cardiac death (SCD) because of lethal VAs.…”

mentioning

confidence: 99%

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Usefulness of Testing for Coronary Artery Spasm and Programmed Ventricular Stimulation in Survivors of Out-of-Hospital Cardiac Arrest

Komatsu

Takahashi

Fukuda

et al. 2016

Circ: Arrhythmia and Electrophysiology

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Background-Optimal therapy for patients resuscitated from out-of-hospital cardiac arrest (OHCA) who are not found to have structural heart disease remains to be established, especially regarding the use of implantable cardioverterdefibrillators. Coronary artery spasm (CAS) and lethal ventricular arrhythmias are important causes of OHCA. Methods and Results-In 47 consecutive OHCA survivors without structural heart disease who had fully recovered (M/F 44/3, 43±13 years.), we performed dual induction tests, including acetylcholine provocation test first followed by programmed ventricular stimulation after 1 to 2 weeks. Patients with CAS were treated with calcium channel blockerbased antianginal medications; implantable cardioverter-defibrillators were implanted in all patients. The results of the dual induction tests defined 4 groups: CAS alone (n=7), inducible ventricular arrhythmias alone (n=13), both positive (n=24), and both negative (n=3). During a median follow-up period of 38 months, ventricular fibrillation recurred in all groups except the both-negative group. Of the 16 patients with a type I Brugada ECG, 2 had CAS alone, 8 had ventricular arrhythmias alone, and 6 had both positive. No ventricular fibrillation episodes were observed in the CAS-alone patients who did not also have Brugada syndrome. Kaplan-Meier analysis showed that the CAS-alone group was at lower risk for OHCA recurrence as compared with the Brugada syndrome group (log-rank test; P=0.036). Conclusions-Among OHCA survivors without structural heart disease, provokable CAS and ventricular arrhythmias are common and can be seen in Brugada syndrome. CAS alone without Brugada syndrome who are treated for CAS may be a lower-risk group. (Circ Arrhythm Electrophysiol. 2016;9:e003798.

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Section: Study Populationmentioning

confidence: 93%

Section: Heterogeneity In the Pathogenesis Of Ohca Without Organic Hementioning

confidence: 99%

mentioning

confidence: 99%

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Usefulness of Testing for Coronary Artery Spasm and Programmed Ventricular Stimulation in Survivors of Out-of-Hospital Cardiac Arrest

Komatsu

Takahashi

Fukuda

et al. 2016

Circ: Arrhythmia and Electrophysiology

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“…Recurrent ischemia may not be significantly associated with SCD, whereas heart failure due to MI markedly increases the risk of SCD [27]. Interestingly, acute ischemia is an established cause of VF and polymorphic VT [28], whereas cardiac death in patients with nonischemic dilated cardiomyopathy and functional class IV heart failure is more often due to bradyarrhythmia or electromechanical dissociation than due to ventricular tachyarrhythmias [29].…”

Section: Sudden Cardiac Deathmentioning

confidence: 99%

Implantable Cardioverter-Defibrillators in Sudden Cardiac Death Prevention: What Guidelines Don't Tell

Giaccardi¹,

Colella²,

Santoro³

et al. 2013

Cardiac Defibrillation

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“…The prevalence of CAS in patients resuscitated from cardiopulmonary arrest ranges from 3.3% to 8.6% 3, 4, 5, 6. It is known that CAS may induce fatal ventricular arrhythmias without apparent chest symptoms 7, 8. In addition, inferolateral J wave has been associated with an increased risk of fatal ventricular arrhythmias in patients with CAS 9, 10, 11.…”

mentioning

confidence: 99%

Significance of Coronary Artery Spasm Diagnosis in Patients With Early Repolarization Syndrome

Kamakura

Wada

Ishibashi

et al. 2018

JAHA

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BackgroundPreviously described patients with early repolarization syndrome (ERS) may have experienced silent coronary artery spasm (CAS) because the diagnosis of CAS was mainly based on symptoms or coronary angiography findings, without performing a spasm provocation test. This study investigated the significance of CAS diagnosis and evaluated the incidence of silent CAS in patients with possible ERS (ie, idiopathic ventricular fibrillation [VF] and inferolateral J wave).Methods and ResultsThe study included 34 patients with idiopathic VF and inferolateral J wave. Thirteen patients (38%) were diagnosed as having CAS on the basis of coronary angiography with spasm provocation test (n=8) and documentation of spontaneous ST elevation (n=5). Of the 13 patients with CAS, 5 (38%) did not experience chest symptoms before and during VF, and were diagnosed as having silent CAS. The remaining 21 patients (62%), with a negative provocation test result and absence of chest symptoms, were considered to have ERS. During the 92 months of follow‐up, patients with CAS receiving appropriate medical treatment with antianginal drugs showed a favorable outcome. In contrast, 4 of 21 patients with ERS (19%) had VF recurrences. The use of monotherapy or combination therapy, consisting of quinidine, cilostazol, and bepridil, in the 4 patients with ERS, was effective in suppressing VF.ConclusionsApproximately 40% of patients with CAS with documented VF and inferolateral J wave did not experience chest symptoms at the first VF, and could have been misdiagnosed as having ERS. The use of the spasm provocation test is considered essential to differentiate patients for optimal medical treatment.

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Life-Threatening Ventricular Arrhythmias in Patients with Silent Myocardial Ischemia Due to Coronary Artery Spasm

Cited by 356 publications

References 40 publications

Usefulness of Testing for Coronary Artery Spasm and Programmed Ventricular Stimulation in Survivors of Out-of-Hospital Cardiac Arrest

Usefulness of Testing for Coronary Artery Spasm and Programmed Ventricular Stimulation in Survivors of Out-of-Hospital Cardiac Arrest

Implantable Cardioverter-Defibrillators in Sudden Cardiac Death Prevention: What Guidelines Don't Tell

Significance of Coronary Artery Spasm Diagnosis in Patients With Early Repolarization Syndrome

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