title: Clinical implications of an implantable cardioverter-defibrillator in patients with vasospastic angina and lethal ventricular arrhythmia.
abstract: OBJECTIVE
  The present study was performed to investigate the clinical implications of an implantable cardioverter-defibrillator (ICD) in patients with vasospastic angina (VSA) resuscitated from lethal ventricular arrhythmia.
  
  
  BACKGROUND
  The prognosis of VSA is known to be good with medication; however, ventricular arrhythmia and cardiopulmonary arrest are rare but life-threatening complications of this disease. The ICD is a proven modality for patients with ventricular arrhythmia, but the clinical implications in this population remain to be elucidated.
  
  
  METHODS
  We conducted a retrospective, observational, multicenter study involving patients with an ICD due to documented ventricular arrhythmia and VSA diagnosed by acetylcholine provocation test. All patients were followed up for appropriate ICD therapy, sudden cardiac arrest, or death from all causes.
  
  
  RESULTS
  Twenty-three patients were included in the present study and completely followed up. All patients are still alive. During a follow-up of 2.9 years (median 2.1 years), 4 ventricular fibrillations and 1 episode of pulseless electrical activity occurred in 5 patients (21.7%). There were no statistically significant differences in patient characteristics between the recurrence and nonrecurrence groups, including medication, smoking status, and whether the patient was or was not free of symptoms after ICD implantation.
  
  
  CONCLUSIONS
  Patients with VSA and lethal ventricular arrhythmia are a population at high risk for recurrence of cardiopulmonary arrest, and there is no reliable indicator for predicting recurrence of ventricular arrhythmia. Insertion of an ICD with medication for VSA is appropriate for this high-risk population.
authors: Department of Cardiology, Kameda Medical Center, Chiba, Japan.
authors: Yuya
authors: Y
authors: Matsue
authors: Makoto
authors: M
authors: Suzuki
authors: Mitsuhiro
authors: M
authors: Nishizaki
authors: Rintaro
authors: R
authors: Hojo
authors: Yuji
authors: Y
authors: Hashimoto
authors: Harumizu
authors: H
authors: Sakurada
mesh_terms: D000109:Acetylcholine; D000328:Adult; D000368:Aged; D000788:Angina Pectoris, Variant / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D044466:Asian People; D018678:Cholinergic Agents; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000150:complications / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018401:Sample Size; D017180:Tachycardia, Ventricular / Q000150:complications / Q000175:diagnosis / Q000628:therapy*
chemical_list: D018678:Cholinergic Agents; D000109:Acetylcholine