Pacing and clinical electrophysiology : PACE · 2025
Indication of Implantable Cardioverter Defibrillators for Ventricular Arrhythmias in Coronary Spastic Angina.
СтатьяНазвание и аннотация: Перевод в очереди
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Tani Kenichi, Takami Mitsuru, Imamura Kimitake, Suehiro Hideya, Yatomi Atsusuke, Iwai Hidehiro, Nakanishi Yusuke, Shoda Mitsuhiko, Murakami Atsushi, Yonehara Shogo, Asada Hiroyuki, Kunigita Takahiro, Yamamoto Mari, Doi Tomofumi, Hirata Ken-Ichi, Otake Hiromasa, Fukuzawa Koji
Аннотация
BACKGROUND: Coronary spastic angina (CSA) sometimes complicates ventricular arrhythmias (VAs) leading to sudden death. The appropriate secondary prevention strategy remains to be discussed. Recently, the relationship between J waves and VAs in CSA has been reported.
OBJECTIVES: We aimed to investigate the incidence of VAs, J waves, the spatial relationship between J waves and culprit coronary spasm lesions, and VA recurrences in CSA.
METHODS: The patient characteristics, including the presence of J waves, were assessed in 130 CSA patients, and the spatial relationship between J waves and ischemic lesions was analyzed; a concordant pattern was defined when the localization of electrical and coronary blood supply abnormalities matched.
RESULTS: Thirty one patients (24%) had VAs (VA group) and 99 (76%) did not (non-VA group). More J waves were observed in the VA group than the non-VA group (19 of 31 patients [61%] vs. 16 of 99 patients [16%], p = 0.00003). A concordant pattern between the J waves and culprit coronary spasm lesions was significantly observed greater in the VA group than the non-VA group (14 of 19 patients [74%] vs. 5 of 16 patients [31%], p = 0.019). VAs reoccurred in 6 of 31 patients (19%) despite adequate medication during a mean of 4.6 years of follow-up and were not predictable.
CONCLUSIONS: VAs occurred in one-quarter of the CSA patients and were closely related to J waves. The spatial concordance between coronary ischemia and electrical abnormalities might be a risk of a VA occurrence. VA recurrences are highly observed and unpredictable, justifying the indication of an implantable cardioverter defibrillator as secondary prevention.
OBJECTIVES: We aimed to investigate the incidence of VAs, J waves, the spatial relationship between J waves and culprit coronary spasm lesions, and VA recurrences in CSA.
METHODS: The patient characteristics, including the presence of J waves, were assessed in 130 CSA patients, and the spatial relationship between J waves and ischemic lesions was analyzed; a concordant pattern was defined when the localization of electrical and coronary blood supply abnormalities matched.
RESULTS: Thirty one patients (24%) had VAs (VA group) and 99 (76%) did not (non-VA group). More J waves were observed in the VA group than the non-VA group (19 of 31 patients [61%] vs. 16 of 99 patients [16%], p = 0.00003). A concordant pattern between the J waves and culprit coronary spasm lesions was significantly observed greater in the VA group than the non-VA group (14 of 19 patients [74%] vs. 5 of 16 patients [31%], p = 0.019). VAs reoccurred in 6 of 31 patients (19%) despite adequate medication during a mean of 4.6 years of follow-up and were not predictable.
CONCLUSIONS: VAs occurred in one-quarter of the CSA patients and were closely related to J waves. The spatial concordance between coronary ischemia and electrical abnormalities might be a risk of a VA occurrence. VA recurrences are highly observed and unpredictable, justifying the indication of an implantable cardioverter defibrillator as secondary prevention.