Inferior J waves in patients with vasospastic angina might be a risk factor for ventricular fibrillation

“…It has been reported that the appearance or progression of ER is sometimes observed during acute myocardial ischemia in patients with coronary artery disease. Furthermore, VSA patients with ER, especially its day-to-day variation, develop VF more frequently than those without ER, even during the asymptomatic phase (2,3). On the other hand, Inamura et al reported the VSA patients with fatal arrhythmic events showed a high incidence of ER and positive for TWA during the symptom-free period, which exhibits potentially depolarization and repolarization abnormalities (4).…”

Section: Discussionmentioning

confidence: 99%

Ventricular Fibrillation Induced by Coronary Vasospasm in a Patient with Early Repolarization and Hyperthyroidism

et al. 2018

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Vasospastic angina (VSA) has been recognized as a cause of ventricular fibrillation (VF) degenerating into sudden cardiac death. We experienced a case of VSA with hyperthyroidism in which VF was provoked with an augmented J-wave amplitude in the inferior leads. The patient underwent insertion of an implantable cardioverter-defibrillator for the secondary prevention of VF in addition to taking Ca-channel antagonists. He has shown no recurrence of fatal arrhythmia or anginal attack for a follow-up period of one year.

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“…4 . Some CSA cases are complicated with early repolarization or Brugada syndrome ( 16 ). These patients' prognosis are unfavorable compared to those of patients with pure CSA ( 17 - 19 ).…”

Section: Discussionmentioning

confidence: 99%

Spasm Provocation Tests under Medication May Help Decide on Medical or Mechanical Therapy in Patients with Aborted Sudden Cardiac Death due to Coronary Spasm

2020

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Background The decision to perform medical or mechanical therapy in patients with aborted sudden cardiac death (ASCD) due to coronary spasm is controversial. The Japanese Circulation Society guidelines for the diagnosis and treatment of patients with coronary spastic angina mentioned that implantable cardioverterdefibrillator (ICD) is one option in patients with ASCD due to coronary spasm. Objectives We investigated the usefulness of spasm provocation tests under medications in five patients with ASCD due to coronary spasm. Methods We performed the spasm provocation tests under medications in five ASCD patients due to coronary spasm. Pharmacological spasm provocation tests, including five acetylcholine (ACh) tests, two ergonovine (ER) tests, and two ACh added after ER tests, were performed to estimate the effect of medications to suppressing the next fatal spasms. Results ACh tests under medications did not provoke spasm in one patient but did provoke in two patients. In the remaining two patients, neither the ACh test nor the ER test provoked spasm, but the ACh added after ER test induced a focal spasm in one coronary artery. We ncreased the medication dosage in four patients. An ICD was implanted in two patients, including one with refractory spasm and one with left main trunk spasm. One patient died due to pulseless electrical activity without ventricular fibrillation, while the remaining four patients survived. Conclusions Spasm provocation tests under medication in patients with ASCD due to coronary spasm may be an option when deciding on medical or mechanical therapy.

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Inferior J waves in patients with vasospastic angina might be a risk factor for ventricular fibrillation

Abstract: The results suggest that the existence of J waves, especially in the inferior leads, might be a risk factor for VF in VSA patients.

Cited by 14 publications

References 31 publications

Early repolarization is involved in ventricular fibrillation in patients with variant angina

Early repolarization is involved in ventricular fibrillation in patients with variant angina

Ventricular Fibrillation Induced by Coronary Vasospasm in a Patient with Early Repolarization and Hyperthyroidism

Spasm Provocation Tests under Medication May Help Decide on Medical or Mechanical Therapy in Patients with Aborted Sudden Cardiac Death due to Coronary Spasm

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