Should an implanted defibrillator be considered in patients with vasospastic angina?

• Published in: Archives of cardiovascular diseases 2014-01, Vol.107 (1), p.42-47
• Main Authors: Eschalier, Romain, Souteyrand, Géraud, Jean, Frédéric, Roux, Antoine, Combaret, Nicolas, Saludas, Yannick, Clerfond, Guillaume, Barber-Chamoux, Nicolas, Citron, Bernard, Lusson, Jean-René, Brugada, Pedro, Motreff, Pascal
• Format: Article
• Language: English
• Subjects: Angina Pectoris - diagnosis; Angina Pectoris - mortality; Angina Pectoris - physiopathology; Angina Pectoris - therapy; Arrhythmias, Cardiac - diagnosis; Arrhythmias, Cardiac - mortality; Arrhythmias, Cardiac - physiopathology; Arrhythmias, Cardiac - prevention & control; Cardiovascular; Coronary Angiography; Coronary vasospasm; Coronary Vasospasm - diagnosis; Coronary Vasospasm - mortality; Coronary Vasospasm - physiopathology; Coronary Vasospasm - therapy; Death, Sudden, Cardiac - etiology; Death, Sudden, Cardiac - prevention & control; Defibrillators, Implantable; Défibrillateur automatique implantable; Electric Countershock - instrumentation; Electrocardiography; Female; Humans; Implantable defibrillator; Internal Medicine; Male; Middle Aged; Mort subite; Patient Selection; Predictive Value of Tests; Prosthesis Design; Risk Assessment; Risk Factors; Smoking - adverse effects; Smoking Cessation; Smoking Prevention; Spasme coronaire; Sudden cardiac death; Tomography, Optical Coherence; Treatment Outcome; Trouble du rythme ventriculaire; Ventricular arrhythmia
• ISSN: 1875-2136; 1875-2128
• DOI: 10.1016/j.acvd.2013.10.006

Summary Vasospastic angina is a frequent and well-recognized pathology with a high risk of life-threatening ventricular arrhythmias and sudden cardiac death. The diagnosis of vasospastic angina requires the combination of clinical and electrocardiographic variables and the results of provocation tests, such as ergonovine administration. Smoking cessation is the first step in the management of vasospastic angina. Optimal medical treatment using calcium-channel blockers and/or nitrate derivatives can provide protection, but life-threatening ventricular arrhythmias may occur despite optimal medical treatment and several years after the start of treatment. In this review, we evaluate the role of implantable defibrillators as a complement to optimal medical management in patients with life-threatening ventricular arrhythmias due to vasospastic angina; this role is not well characterized in the literature or guidelines. We discuss the role of implantable defibrillators in secondary prevention in light of three recent cases managed in our departments and a review of the literature. An implantable defibrillator was implanted in two of the three cases of vasospastic angina with ventricular arrhythmias that we managed. We considered secondary prevention by implantable defibrillator to be justified even in the absence of any obvious risk factor. Ventricular arrhythmias recurred during implantable defibrillator follow-up in the two patients implanted. Conclusion In patients with life-threatening ventricular arrhythmias due to vasospastic angina, an implantable defibrillator should be considered because of the risk of recurrence despite optimal medical management.