Abstract 15383: Clinical Features and Prognosis of Patients Who Survived Ventricular Fibrillation Due to Coronary Artery Spasm

Abstract

Introduction: Coronary artery spasm can lead to lethal arrhythmia and sudden cardiac death. The aim of this study was to elucidate the clinical features and prognosis of patients who survived cardiac arrest due to coronary artery spasm. Methods: We retrospectively studied consecutive patients who survived ventricular fibrillation out of hospital cardiac arrest due to coronary artery spasm, and discharged neurologically intact. Results: Nineteen patients (18 men and 1 woman, mean age 55 ± 10 years) were enrolled. In all patients, ventricular fibrillation (VF) was documented as the initial rhythm at cardiac arrest. Transient ST-segment elevation during spontaneous attack was observed in 9 patients. Acetylcholine provocation tests were performed and resulted in positive in 15 patients. In 11 patients, cardiac arrest was the first episode of vasospastic attack. All patients were treated with vasodilators including calcium channel blockers. An implantable defibrillator (ICD) was implanted in 12 patients according to the discretion of the attending physician. During a mean follow-up interval of 42 months, 4 episodes of VF were observed in 3 patients and ST-segment elevation myocardial infarction (STEMI) was observed in 1 patient. Two episodes of VF were occurred before the diagnosis of coronary artery spasm was confirmed during the index hospitalization, and the other 2 VF were occurred after ICD implantation. All VF were treated by manual defibrillation or ICD shocks. None of patients developed cardiovascular death. There are no differences in the characteristics of the patients between those with and without recurrence of VF and STEMI. However, medications against coronary artery spasm were discontinued before the cardiac events in all episodes of VF and STEMI. The intervals between cessation of medications and cardiac events were less than 2 days in all cardiac events. Conclusions: The patients who survived cardiac arrest due to coronary artery spasm were at high risk for recurrence of severe ischemia and lethal arrhythmia. Cessation of medication, even within a few days, was closely associated with cardiac events. ICD therapy may be beneficial in patients who survived cardiac arrest due to coronary artery spasm.