Moisés Rodríguez-Mañero1, Teresa Oloriz2, Jean-Benoit le Polain de Waroux3, Haran Burri4, Bahij Kreidieh1, Carlos de Asmundis5, Miguel A Arias6, Elena Arbelo7, Brais Díaz Fernández1, Juan Fernández-Armenta8, Nuria Basterra9, María Teresa Izquierdo10, Ernesto Díaz-Infante11, Gabriel Ballesteros12, Andrés Carrillo López13, Ignacio García-Bolao13, Juan Benezet-Mazuecos14, Victor Expósito-García15, Jose Luis Martínez-Sande1, Javier García-Seara1, Jose Ramón González-Juanatey1, Rafael Peinado16. 1. Cardiology Department, Complejo Hospital Universitario Santiago de Compostela, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Santiago de Compostela, Spain. 2. Electrophysiology Unit, Cardiology Service, Hospital Miguel Servet Zaragoza, Zaragoza, Spain. 3. Cliniques universitaire Saint-Luc, Université de Louvain, Brussels. 4. Electrophysiology Unit, Cardiology Service, University Hospital of Geneva, Geneva, Switzerland. 5. Vrije Universiteit Brussel, Electrophysiology Unit, Brussels, Belgium. 6. Electrophysiology Unit, Cardiology Service, Hospital Virgen de la Salud, Toledo, Spain. 7. Electrophysiology Unit, Cardiology Service, Hospital Clinic Barcelona, Barcelona, Spain. 8. Electrophysiology Unit, Cardiology Service, Hospital Puerta del Mar, Cádiz, Spain. 9. Electrophysiology Unit, Cardiology Service, Hospital Universitario La Fe, Valencia, Spain. 10. Electrophysiology Unit, Cardiology Service, Hospital Clínico Universitario de Valencia, Valencia, Spain. 11. Electrophysiology Unit, Cardiology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain. 12. Electrophysiology Unit, Cardiology Service, Clínica Universidad de Navarra, Pamplona. Navarra, Spain. 13. Coronary and Intensive Care Unit, University Hospital Son Espases, Palma de Mallorca, Spain. 14. Electrophysiology Unit, Cardiology Service, Hospital Fundación Jiménez Díaz, Madrid, Spain. 15. Electrophysiology Unit, Cardiology Service, Hospital Universitario Marqués de Valdecilla, Santander, Spain. 16. Electrophysiology Unit, Cardiology Service, Hospital Universitario La Paz, Madrid, Spain.
Abstract
Aims: Coronary artery spasm (CAS) is associated with ventricular arrhythmias (VA). Much controversy remains regarding the best therapeutic interventions for this specific patient subset. We aimed to evaluate the clinical outcomes of patients with a history of life-threatening VA due to CAS with various medical interventions, as well as the need for ICD placement in the setting of optimal medical therapy. Methods and results: A multicentre European retrospective survey of patients with VA in the setting of CAS was aggregated and relevant clinical and demographic data was analysed. Forty-nine appropriate patients were identified: 43 (87.8%) presented with VF and 6 (12.2%) with rapid VT. ICD implantation was performed in 44 (89.8%). During follow-up [59 (17-117) months], appropriate ICD shocks were documented in 12. In 8/12 (66.6%) no more ICD therapies were recorded after optimizing calcium channel blocker (CCB) therapy. SCD occurred in one patient without ICD. Treatment with beta-blockers was predictive of appropriate device discharge. Conversely, non-dihydropyridine CCB therapy was significantly protective against VAs. Conclusion: Patients with life-threatening VAs secondary to CAS are at particularly high-risk for recurrence, especially when insufficient medical therapy is administered. Non-dihydropyridine CCBs are capable of suppressing episodes, whereas beta-blocker treatment is predictive of VAs. Ultimately, in spite of medical intervention, some patients exhibited arrhythmogenic events in the long-term, suggesting that ICD implantation may still be indicated for all.
Aims: Coronary artery spasm (CAS) is associated with ventricular arrhythmias (VA). Much controversy remains regarding the best therapeutic interventions for this specific patient subset. We aimed to evaluate the clinical outcomes of patients with a history of life-threatening VA due to CAS with various medical interventions, as well as the need for ICD placement in the setting of optimal medical therapy. Methods and results: A multicentre European retrospective survey of patients with VA in the setting of CAS was aggregated and relevant clinical and demographic data was analysed. Forty-nine appropriate patients were identified: 43 (87.8%) presented with VF and 6 (12.2%) with rapid VT. ICD implantation was performed in 44 (89.8%). During follow-up [59 (17-117) months], appropriate ICD shocks were documented in 12. In 8/12 (66.6%) no more ICD therapies were recorded after optimizing calcium channel blocker (CCB) therapy. SCD occurred in one patient without ICD. Treatment with beta-blockers was predictive of appropriate device discharge. Conversely, non-dihydropyridine CCB therapy was significantly protective against VAs. Conclusion:Patients with life-threatening VAs secondary to CAS are at particularly high-risk for recurrence, especially when insufficient medical therapy is administered. Non-dihydropyridine CCBs are capable of suppressing episodes, whereas beta-blocker treatment is predictive of VAs. Ultimately, in spite of medical intervention, some patients exhibited arrhythmogenic events in the long-term, suggesting that ICD implantation may still be indicated for all.
Authors: Juan Benezet-Mazuecos; José Antonio Iglesias; José Manuel Rubio; Pepa Sanchez-Borque; Angel Miracle Journal: J Interv Card Electrophysiol Date: 2018-09-14 Impact factor: 1.900