Indication of Implantable Cardioverter Defibrillators for Ventricular Arrhythmias in Coronary Spastic Angina.

IF 1.7 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Pace-Pacing and Clinical Electrophysiology Pub Date : 2025-05-10 DOI:10.1111/pace.15194

Kenichi Tani, Mitsuru Takami, Kimitake Imamura, Hideya Suehiro, Atsusuke Yatomi, Hidehiro Iwai, Yusuke Nakanishi, Mitsuhiko Shoda, Atsushi Murakami, Shogo Yonehara, Hiroyuki Asada, Takahiro Kunigita, Mari Yamamoto, Tomofumi Doi, Ken-Ichi Hirata, Hiromasa Otake, Koji Fukuzawa

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引用次数: 0

Abstract

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.

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植入式心律转复除颤器治疗冠心病痉挛性心绞痛室性心律失常的适应症。

背景：冠状动脉痉挛性心绞痛（CSA）有时并发室性心律失常（VAs）导致猝死。适当的二级预防战略仍有待讨论。最近有研究报道了脑脊液中J波与VAs的关系。目的：探讨CSA中VAs、J波的发生率、J波与罪魁祸首冠状动脉痉挛病变的空间关系以及VA的复发情况。方法：分析130例CSA患者的特征，包括是否存在J波，并分析J波与缺血性病变的空间关系；当电和冠状动脉血液供应异常的定位匹配时，定义了一个一致的模式。结果：有VA组31例（24%）有VAs，无VA组99例（76%）无VAs。VA组比非VA组观察到更多的J波（31例患者中有19例[61%]vs. 99例患者中有16例[16%]，p = 0.00003）。VA组J波与罪魁祸首冠状动脉痉挛病变的一致性明显高于非VA组（19例患者中有14例[74%]比16例患者中有5例[31%]，p = 0.019）。尽管在平均4.6年的随访期间给予充分的药物治疗，31名患者中有6名（19%）VAs复发，并且无法预测。结论：四分之一的CSA患者出现VAs，且与J波密切相关。冠状动脉缺血与电异常之间的空间一致性可能是发生房颤的危险因素。VA的复发是高度观察和不可预测的，证明植入式心律转复除颤器作为二级预防的适应症是合理的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pace-Pacing and Clinical Electrophysiology 医学-工程：生物医学

CiteScore

2.70

自引率

5.60%

发文量

209

审稿时长

2-4 weeks

期刊介绍： Pacing and Clinical Electrophysiology (PACE) is the foremost peer-reviewed journal in the field of pacing and implantable cardioversion defibrillation, publishing over 50% of all English language articles in its field, featuring original, review, and didactic papers, and case reports related to daily practice. Articles also include editorials, book reviews, Musings on humane topics relevant to medical practice, electrophysiology (EP) rounds, device rounds, and information concerning the quality of devices used in the practice of the specialty.