B-PO03-216 VENTRICULAR TACHYCARDIA SECONDARY TO CORONARY VASOSPASM: A CASE SERIES

Abstract

Coronary vasospasm is a well-described mechanism for recurrent VT. To describe clinical characteristics and long-term outcomes of patients with VT secondary to vasospasm. This is a retrospective case series performed by chart review of all patients with documented VT due to coronary vasospasm at the Hospital of the University of Pennsylvania. Between 2005 and 2020, 4 patients were diagnosed with VT secondary to vasospasm based on transient ST-segment deviation preceding VT episodes (figure). Clinical characteristics were as follows: ages 35 to 66 years-old; 3 men and 1 woman; and 1 with family history of sudden cardiac death. Clinical presentation was variable: 1 recurrent angina, 1 recurrent syncope, 1 resuscitated cardiac arrest, 1 arrhythmic storm. All had normal EF (55% to 65%) and underwent cardiac catheterization, showing severe disease in only in 1 patient (80% proximal LAD treated with stent). All experienced angina preceding polymorphic VT. Time interval between ST segment deviation and VT onset was 120 to 300 seconds. One was misdiagnosed as CPVT and 1 as idiopathic VF prior to referral. All received secondary-prevention ICD (2 subcutaneous) and medical therapy with calcium-channel blockers (4 patients) with or without nitrates (2 patients). Recurrent VT was seen in 1 patient after initiating medical therapy, appropriately treated with an ICD shock; the other 3 patients had no recurrence (6 months to 12 years follow-up). Coronary vasospasm is a rare, but important cause of VT. Secondary prevention ICD may have a role in management given observed recurrence despite appropriate medical therapy in one patient in this series.