P3-115: Recurrent polymorphic ventricular tachycardia associated with variant angina effective treatment with implantable cardioverter defibrillator

Abstract

A 66 year-old man presented with recurrent nonexertional, substernal chest pain. The baseline ECG showed sinus bradycardia. Cardiac enzymes, exercise stress test, and echocardiogram were normal. On the first night, he was awakened by chest pain followed by repetitive bursts of nonsustained ventricular tachycardia, which spontaneously resolved. Cardiac catheterization revealed minimal atherosclerotic disease. An electrophysiology study showed no inducible ventricular arrhythmias, and a beta-blocker was initiated. He awoke with substernal chest pain the next night and the ECG monitor revealed ST segment elevation followed by rapid polymorphic ventricular tachycardia (VT) at 174 BPM (Figure 1, A-D). Vasospasm-induced ischemia was diagnosed and management was changed to nifedipine extended-release (ER) at a dose of 90 mg daily. VT recurred despite medical therapy, an ICD was implanted. A day after discharge, the patient experienced chest pain followed by an ICD shock. The electrogram recorded by the ICD showed rapid ventricular tachycardia at 267 BPM (Figure 2). The patient’s nifedipine ER dose was increased to 60 mg twice daily. The patient had no chest pain or ICD events at one-month follow-up. There is a paucity of data regarding the use of ICDs in cases of vasospastic angina with ventricular arrhythmias. We implanted an ICD because of the malignant nature of the patient’s arrhythmia and the inability to test the efficacy of therapy in preventing recurrence. Our case demonstrates the effectiveness of ICD therapy in this setting. View Large Image Figure Viewer