title: Should an implanted defibrillator be considered in patients with vasospastic angina?
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Cardiology Department, Clermont-Ferrand University Hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France; Clermont université, université d'Auvergne, CArdio-Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, Clermont-Ferrand, France. Electronic address: reschalier@chu-clermontferrand.fr.
authors.forename: Romain
authors.initials: R
authors.lastname: Eschalier
authors.affiliation: Cardiology Department, Clermont-Ferrand University Hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France; Clermont université, université d'Auvergne, CArdio-Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, Clermont-Ferrand, France.
authors.forename: Géraud
authors.initials: G
authors.lastname: Souteyrand
authors.affiliation: Cardiology Department, Clermont-Ferrand University Hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Jean
authors.affiliation: Cardiology Department, Clermont-Ferrand University Hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Roux
authors.affiliation: Cardiology Department, Clermont-Ferrand University Hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Combaret
authors.affiliation: Cardiology Department, Clermont-Ferrand University Hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Saludas
authors.affiliation: Cardiology Department, Clermont-Ferrand University Hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France; Clermont université, université d'Auvergne, CArdio-Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, Clermont-Ferrand, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Clerfond
authors.affiliation: Cardiology Department, Clermont-Ferrand University Hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Barber-Chamoux
authors.affiliation: Cardiology Department, Clermont-Ferrand University Hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Citron
authors.affiliation: Cardiology Department, Clermont-Ferrand University Hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France; Clermont université, université d'Auvergne, CArdio-Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, Clermont-Ferrand, France.
authors.forename: Jean-René
authors.initials: JR
authors.lastname: Lusson
authors.affiliation: Cardiovascular Division, Free University of Brussels, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Pedro
authors.initials: P
authors.lastname: Brugada
authors.affiliation: Cardiology Department, Clermont-Ferrand University Hospital, 58, rue Montalembert, 63000 Clermont-Ferrand, France; Clermont université, université d'Auvergne, CArdio-Vascular Interventional Therapy and Imaging (CaVITI), Image Science for Interventional Techniques (ISIT), UMR6284, Clermont-Ferrand, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Motreff
mesh_terms: D000787:Angina Pectoris / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation; D000074606:Smoking Prevention; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
keywords: Coronary vasospasm; Défibrillateur automatique implantable; Implantable defibrillator; Mort subite; Spasme coronaire; Sudden cardiac death; Trouble du rythme ventriculaire; Ventricular arrhythmia