Programmed Ventricular Stimulation During Variant Angina: Report of a Case

Abstract

Programmed ventricular stimulation was performed in a 74-year-old patient who had a history of syncope following chest pain. In the baseline state, ventricular tachycardia was not inducible. Immediately following the study protocol, the patient complained of her usual chest pain and ST elevation was documented in lead II with reciprocal ST depression in leads AVF and V1. Programmed ventricular stimulation was repeated (presumably during the occlusive phase of coronary spasm) and a polymorphic ventricular tachycardia with a cycle length of 200 msec was repeatedly induced. Following intravenous nitroglycerin and resolution of chest pain, ventricular tachycardia was not inducible. Coronary angiography with ergonovine testing confirmed coronary spasm of the right coronary artery. We speculate that syncope was caused by ventricular tachycardia following coronary artery spasm. During a 12-month follow-up with calcium blockers and nitrates, there has been no recurrence of chest pain or syncope.