Polymorphic Ventricular Tachycardia in Patients With Vasospastic Angina

Abstract

he clinical characteristics and mechanism of polymorphic ventricular tachycardia (VT) in the setting of prolonged Q-T interval have extensively been studied, 1-3 but polymorphic VT with normal Q-T interval has infrequently been reported and most reports concern its development in the early stage of acute myocardial infarction. 4,5 Eisenberg et al described 15 patients who exhibited polymorphic VT and normal QT interval in the absence of apparent structural heart disease, 6 and of these he found that only 2 had polymorphic VT during episodes of coronary artery spasm.Recently, using electrophysiologic studies (EPS) and examination of QT dispersion on 12-lead surface ECG, we reported that patients with vasospastic angina (VSA) exhibit inhomogeneity of ventricular repolarization and increased ventricular vulnerability, even during the symptom-free period. 7-9 These life-threatening ventricular arrhythmias are one of the most serious complication of ischemic attack caused by coronary spasm, and are associated with an Japanese Circulation Journal Vol. 65, June 2001 increased risk of sudden cardiac death. [10][11][12][13][14] However, to the best of our knowledge, there have been few clinical studies exploring the clinical and electrocardiographic characteristics and prospective long-term follow-up of spontaneous polymorphic VT developing during a vasospastic attack. Therefore, we investigated the characteristics of spontaneous polymorhpic VT in patients withVSA and their longterm outcome. Methods PatientsThe study group comprised 60 Japanese patients with VSA (44 men, 16 women; mean age, 56 years [range, 44-75 years]) consecutively enrolled at Yokohama Minami Kyosai Hospital (single institution) from April 1991 to March 1995. All patients with VSA had a spontaneous episode of angina and coronary vasospasm, defined as total or subtotal (99% with delay) occlusion, or a severe constriction of the vessel associated with myocardial ischemic ST segment changes on ECG and chest pain after the intracoronary injection of acetylcholine. No symptomatic significant coronary stenosis on baseline angiograms and no history of myocardial infarction were noted in any of the 60 patients. None had evidence of cardiomyopathy, congestive heart failure, peptic ulcer, chronic obstructive lung disease or other serious cardiopulmonary diseases. All patients had normal ventricular function without segmental wall motion abnormality on the resting M-mode and 2-dimensional echocardiogram. Doppler echocardiograms revealed no abnormalities in any

Coronary vasospasm-induced periodic ventricular fibrillation and successful ablation through coronary stenting

“…Stenting could be considered in cases where vasospasm-related symptoms could not be kept under control using optimal medication. On the other hand, according to a study by Nishizaki et al ., patients in whom coronary vasospasm emerged with ventricular arrhythmia have vulnerable myocardial substrate and always have a risk of sudden cardiac death [ 7 ]. Therefore, an ICD could be considered as a treatment option even after the patient experiences their first attack.…”

Life‐threatening arrhythmias leading to syncope in patients with vasospastic angina

“…However, in general, ventricular tachyarrhythmias have been frequently cited as a major cause of syncope encountered in patients with VSA [11] , [14] , [18] , [19] .…”

“…Syncope can be classified into three categories: reflex syncope, orthostatic hypotension, and cardiac syncope [6] . Especially in Japan, cardiac syncope is occasionally caused by fatal arrhythmia due to coronary spasm in patients with VSA on a substrate of structural disease [11] , [12] , [18] , [19] . We propose a diagnostic flowchart in patients with syncope, specifically a Japanese and Asian version ( Fig.…”

“…We investigated the clinical and electrocardiographic characteristics of spontaneous polymorphic VT (PVT) developing during a vasospastic attack and carried out a prospective long-term follow-up [18] . The study included 60 consecutive patients with VSA.…”

“…Therefore, both coronary spasm triggering SCA and coronary spasm triggering syncope had a similar circadian variation. On the other hand, life-threatening ventricular arrhythmia is considered the most important predictor of SCA in patients with VSA [14] , [17] , [18] . In consequence, fatal arrhythmia triggered by coronary spasm may be pathophysiologically associated with syncope as well as SCA [19] .…”