Abstract 369: Implantable Cardioverter Defibrillator Therapy in Patients With Vasospastic Angina After Sudden Cardiac Arrest

Abstract

Introduction: The prognosis of vasospastic angina (VSA) treated with optimal medication therapy is generally good. However, the patients resuscitated from sudden cardiac arrest (SCA) caused by lethal ventricular arrhythmias are at high risk of recurrent cardiovascular events. Moreover, little is known about the efficacy of implantable cardioverter defibrillator (ICD) therapy in this population The aim of this study is to evaluate the incidence of lethal arrhythmic events in VSA patients with secondary prophylaxis for SCA. Methods: Data from patients who received an ICD as a secondary prophylaxis in our institution between January 2012 and November 2018 were retrospectively analyzed. A total of 123 patients were enrolled in this study and divided into 16 patients with VSA (VSA group) and 107 patients without VSA (non-VSA group). VSA was diagnosed by acetylcholine provocation test or coronary angiography alone on arrival. Results: Current smoker was more prevalent and cardiac function was better in the VSA group. Diabetes mellitus was more prevalent in the non-VSA group. Although VSA patients were treated with calcium-channel blockers, with or without nitrates, 3 patients (18.8%) experienced appropriate ICD therapies due to lethal arrhythmias during a follow-up of 3.2 years. There were no significant differences in the proportion of appropriate and inappropriate therapy between 2 groups. (Table) Conclusions: Recurrent lethal arrhythmic events were common in patients with VSA after SCA. In addition to optimal medical therapy, ICD therapy should be aggressively considered in patients with VSA and a history of lethal arrhythmia.