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Usefulness of implantable cardioverter-defibrillators in refractory variant angina pectoris complicated by ventricular fibrillation in patients with angiographically normal coronary arteries

2002; Elsevier BV; Volume: 89; Issue: 9 Linguagem: Inglês

10.1016/s0002-9149(02)02283-x

1879-1913

Simcha Meisel, Alexander Mazur, Israel Chetboun, Menashe Epshtein, Menahem Canetti, Jacob Gallimidi, Amos Katz, Boris Strasberg, Benny Peled,

Cardiac pacing and defibrillation studies

Variant angina pectoris is characterized by anginal symptoms at rest and transient ST elevation on the electrocardiogram due to coronary artery spasm. 1 Printzemetal M. Kennamer R. Merliss R. Wada T. Bor N. Angina pectoris. I. A variant form of angina pectoris preliminary report. Am J Med. 1959; 27: 375-388 Abstract Full Text PDF PubMed Scopus (1025) Google Scholar , 2 Meller J. Pichard A. Dack S. Coronary arterial spasm in Printzmetal's angina a proved hypothesis. Am J Cardiol. 1976; 37: 938-940 Abstract Full Text PDF PubMed Scopus (103) Google Scholar , 3 Maseri A. Severi S. DeNes M. L'Abbate A. Chierchia S. Marzilli M. Ballestra A.M. Parodi O. Biagini A. Distante A. "Variant" angina pathogenic mechanisms, estimated incidence and clinical and coronary arteriographic findings in 138 patients. Am J Cardiol. 1978; 42: 1019-1035 Abstract Full Text PDF PubMed Scopus (683) Google Scholar Ventricular arrhythmia is a well-recognized complication of this type of angina. 4 Kerin N.Z. Rubenfire M. Naini M. Wajszczuk W.J. Pamatmat A. Cascade P.N. Arrhythmias in variant angina pectoris relationship of arrhythmias to ST-segment elevation and R-wave changes. Circulation. 1979; 60: 1343-1350 Crossref PubMed Scopus (68) Google Scholar , 5 MacAlpin R.N. Cardiac arrest and sudden unexpected death in variant angina complications of coronary spasm that can occur in the absence of severe organic stenosis. Am Heart J. 1993; 125: 1011-1017 Abstract Full Text PDF PubMed Scopus (99) Google Scholar Although calcium antagonists have been shown to be effective in preventing coronary spasm–induced ventricular arrhythmia in most patients with variant angina pectoris and normal coronary arteries, some may remain refractory. 5 MacAlpin R.N. Cardiac arrest and sudden unexpected death in variant angina complications of coronary spasm that can occur in the absence of severe organic stenosis. Am Heart J. 1993; 125: 1011-1017 Abstract Full Text PDF PubMed Scopus (99) Google Scholar , 6 Theroux P. Waters D. Diagnosis and management of patients with unstable angina. in: Alexander R.W. Schlant R.C. Fuster V. Hurst's the Heart, Arteries and Veins. McGraw-Hill, New York1998: 1332-1337 Google Scholar Implantable cardioverter-defibrillators (ICDs) have become a proven modality for patients at high risk of life-threatening ventricular arrhythmias. In the present study we analyzed the clinical course of 8 patients with refractory variant angina pectoris complicated by ventricular fibrillation (VF) who had normal coronary arteries on angiography. We evaluated the efficacy of the ICD in preventing sudden death in this group.