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

Abstract

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.

2020 APHRS/HRS expert consensus statement on the investigation of decedents with sudden unexplained death and patients with sudden cardiac arrest, and of their families

“…Coronary vasospasm, while a recognized cause of cardiac arrest, may not be picked up clinically at presentation. 292 Ergonovine or acetylcholine challenge has been proposed as a Class 1 indication by recent guidelines 293 and was employed selectively in the CASPER experience. 216 Hyperventilation has also been used as a diagnostic test.…”

2020 APHRS/HRS expert consensus statement on the investigation of decedents with sudden unexplained death and patients with sudden cardiac arrest, and of their families

“…Coronary vasospasm, while a recognized cause of cardiac arrest, may not be picked up clinically at presentation 292 . Ergonovine or acetylcholine challenge has been proposed as a Class 1 indication by recent guidelines 293 and was employed selectively in the CASPER experience 216 .…”

Association of early repolarization pattern and ventricular fibrillation in patients with vasospastic angina: A systematic review and meta‐analysis

“…Finally, a total of eight studies were included in the meta‐analysis. 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 The study selection process is shown in Figure S2 (see Figure and Supplemental Content, which illustrates the flow diagram of study selection).…”

“…Finally, a total of eight studies were included in the metaanalysis. [15][16][17][18][19][20][21][22] The study selection process is shown in Figure S2 (see All the selected studies were retrospective cohort studies, which were published between 2011 and 2020, with sample sizes ranging from 34 to 458 patients and a total of 1761 patients. All patients were from South Korea and Japan.…”