Abstract:The presence of ER, especially with day-to-day variation, can help predict VF recurrence in VSA patients. Implantable cardioverter defibrillator implantation is a reasonable approach for the secondary prevention of VF in high-risk VSA patients.
“…Thus, the prevalence of J waves after an MI tended to be high. In a recent study, the J waves in the VSA patients was reported to be 21.4% to 36% [19][20][21][22]. These data are consistent with the results of the current study, where the prevalence of J waves in these subjects was higher than that in the healthy population and lower than that in those post-MI.…”
“…Thus, the prevalence of J waves after an MI tended to be high. In a recent study, the J waves in the VSA patients was reported to be 21.4% to 36% [19][20][21][22]. These data are consistent with the results of the current study, where the prevalence of J waves in these subjects was higher than that in the healthy population and lower than that in those post-MI.…”
“…Oh et al indicated that ER could predict cardiac death and fatal arrhythmias in patients with VSA [27] . Kitamura et al reported that the ER pattern in VSA patients, especially its day-to-day variation, was a good predictor of VF recurrence [28] . In this report, ER was observed more frequently in patients with a history of VF than in those without.…”
Section: Vasospastic Angina (Vsa)mentioning
confidence: 99%
“… Fig. 8 A series of 12-lead ECG tracings and an intracardiac electrogram from a representative case with recurrence of ventricular fibrillation (VF) during the follow-up period [28] . (A) Twelve-lead ECG recorded 13 h after the first VF episode.…”
Section: Vasospastic Angina (Vsa)mentioning
confidence: 99%
“…In addition, several studies have indicated the significance of early repolarization (ER) in VSA patients with fatal arrhythmia [26–28]. Oh et al indicated that ER could predict cardiac death and fatal arrhythmias in patients with VSA [27].…”
Section: Vasospastic Angina (Vsa)mentioning
confidence: 99%
“…Consequently, the investigators concluded that the high prevalence of an ER pattern in VSA patients with a history of VF suggests that its presence is a sign of vulnerability to fatal arrhythmias. The ER pattern, especially its day‐to‐day variation, can be a good predictor of VF recurrence [28].…”
The coronary artery diseases (CAD) that can lead to the occurrence of a syncopal attack include acute coronary syndrome, vasospastic angina, effort angina, and prior myocardial infarction. The possible mechanisms considered to lead to syncope in patients with CAD are pump failure, tachyarrhythmia, bradycardia, and vagal stimulation. Coronary artery spasm, in particular, is occasionally observed in patients with unexplained syncope in Japan. Life-threatening arrhythmias are among the most serious complications of an ischemic attack caused by coronary spasm, and are associated with an increased risk of syncope and/or sudden cardiac death (SCD). Therefore, during the initial evaluation of unexplained syncope, the diagnosis of vasospastic angina (VSA) needs to be made promptly, to avert the risk of SCD as a consequence of syncope triggered by the lethal arrhythmia. The inducibility of polymorphic ventricular tachycardia or ventricular fibrillation, increased QT dispersion, T-wave alternans, and early repolarization during the asymptomatic period are considered risk markers for ventricular arrhythmias during coronary spasm. In view of the conclusions from several studies, implantable cardioverter/defibrillator therapy should be considered in patients who are at high risk for recurrence of syncope due to a fatal ventricular arrhythmia triggered by coronary spasm, despite appropriate medical therapy.
Background
An early repolarization (ER) pattern is a risk factor for ventricular fibrillation (VF) in patients with vasospastic angina (VSA) caused by a coronary artery spasm. However, its detailed characteristics and prognostic value for VF remain unclear. Thus, we investigated the relationship between ER and VF in patients with VSA.
Hypothesis
The ER pattern is associated with VF in patients with VSA.
Methods
In this systematic review and meta‐analysis, we searched PubMed, Embase, Cochrane Library, and Web of Science databases for eligible studies published between January 2011 and December 2020; 8 studies with 1761 patients were included in the final analysis.
Results
The ER pattern significantly predicted adverse cardiovascular events (ACEs) and VF (odds ratio [OR] = 5.13, 95% confidence interval [95% CI]: 3.16–8.35,
p
< .00001 and OR = 5.20, 95% CI: 3.05–8.87,
p
< .00001). The presence of ER in the inferior leads increased the VF risk (OR = 7.80, 95% CI: 4.04–15.05,
p
< .00001), regardless of the J‐point morphology or type of ST‐segment elevation in the ER pattern. A horizontal/descending ST‐segment elevation was significantly associated with VF in patients with or without an ER pattern during a coronary spasm (OR = 2.28, 95% CI: 1.07–4.88,
p
= .03). However, obstructive coronary artery disease was unrelated to the ER pattern (OR = 0.82, 95% CI: 0.27–2.53,
p
= .73).
Conclusions
An ER pattern is significantly associated with an increased risk of ACE in patients with VSA. An inferior ER pattern with horizontal/descending ST‐segment elevation confers the highest risk for VF during VSA onset. Nevertheless, the ER pattern is not associated with obstructive coronary artery disease.
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