Introduction: Coronary artery spasm is one of the causes of life-threatening ventricular arrhythmia and sudden cardiac death, but indication of implantable cardioverter-defibrillator (ICD) is controversial. Our aim is to clarify the clinical features and long term prognosis in patients with coronary artery spasm and ventricular arrhythmia.
Methods: We retrospectively investigated 41 survivors of cardiac arrest without underlying cardiac diseases. All patients underwent coronary angiography, acetylcholine provocation test, electrophysiological study, and ICD implantation.
Results: In 9 patients (60.1±12.0 years old, 8 males) multi-vessel spasm was induced by acetylcholine injection. Ventricular fibrillation (VF) was induced by electrophysiological study in 6 patients (Group A), while VF was not induced in 3 of them (Group B). All patients were treated with calcium channel blockers, and patients in Group A were treated with antiarrhythmic drugs as well. During mean follow up of 50±40 (16-146) months, 2 patients in Group A received appropriate ICD shocks to VF. No patient in Group B received ICD shocks.
Conclusions: ICD is useful to prevent sudden cardiac death in patients with coronary artery spasm and inducible ventricular arrhythmia.