Prognosis of patients with coronary vasospasm after successful resuscitation from ventricular fibrillation

Abstract

a b s t r a c tVentricular fibrillation (VF) is an important cause of sudden cardiac death in patients with coronary vasospasm. Intensive medical treatment against coronary vasospasm is most important for prevention of VF recurrence, and the efficacy of implantable cardioverter-defibrillator (ICD) devices is controversial. We examined 19 consecutive patients with coronary spasm who had been successfully resuscitated from VF between 1993 and 2010, 13 of whom underwent ICD implantation. There were no apparent differences in the results of coronary angiography and acetylcholine provocation test or in medical therapy among them. Six patients underwent electrophysiological tests during the acetylcholine provocation test, and 3 of them showed ventricular arrhythmia. Three patients had recurrent VF under treatment with single calcium channel blocker (CCB), nitrates, and/or nicorandil. Two of them were without ICDs and were left in vegetative states, and the third was successfully resuscitated by an appropriate ICD discharge. The results of our study suggest that dual or multiple CCB treatment is preferable to prevent VF recurrence, and that combined treatment with ICD may be effective for some patients with coronary vasospasm who have been successfully resuscitated from VF. However, reasonable risk stratification for ICD implantation in these patients needs to be established in the future.

Fatal Multi-Vessel Coronary Vasospasm: A Case Report

“…However, the clinical studies on the effectiveness of the ICD are controversial but its role is undeniable to prevent sudden death due to malignant ventricular arrhythmias [14]. Ishihara et al showed that using optimal medical treatment with an ICD may reduce the recurrence of ventricular arrhythmia for some patients with coronary vasospasm who have been successfully resuscitated from ventricular fibrillation or cardiac arrest [15]. On the other hand, Ahn et al found that there was no significant trend of cardiac deaths in patients with ICDs [7].…”

Severe Prinzmetal’s Angina Inducing Ventricular Fibrillation Cardiac Arrest

“…ICD implantation, on the other hand, may be considered for secondary prevention in patients who have had a cardiac arrest secondary to VSA [15]. A recent publication in the Journal of Arrhythmia, by Akiko et al, suggested that combined medical treatment using CCB with an ICD may be effective for reducing recurrent ventricular dysrhythmias for some patients with coronary vasospasm who have been successfully resuscitated from ventricular fibrillation or ventricular tachycardia arrest [16]. Additionally, a retrospective review over 18 years by Ahn et al evaluated a small number of patients with aborted sudden cardiac death (ASCD) and ICD and found there was a nonsignificant trend of cardiac deaths in patients with ICDs compared to those without [17].…”

Life-Threatening Coronary Vasospasm Treated by Implantable Cardioverter Defibrillator: The Warning Signs

“…An article by Ishihara et al discussed the pathophysiology behind vasospasm in detail. They further discussed the use of ICD treatment in vasospasm patients postventricular fibrillation-(VF-) induced cardiac arrest and the importance of carefully weighing up the potential benefit of ICD implantation with a reasonable risk stratification beforehand [4]. This report is an example of a classic presentation of spasm-induced cardiac arrest.…”