title: Early repolarization pattern and its day-to-day dynamic change as markers for ventricular fibrillation in patients with vasospastic angina.
abstract: OBJECTIVE
  An early repolarization (ER) pattern is a risk factor for ventricular fibrillation (VF) in certain diseases. However, it is unclear whether this association holds for patients with vasospastic angina (VSA). Moreover, the reported long-term follow-up of implantable cardioverter defibrillator (ICD) therapy for VSA patients is limited to 3 years. This study aimed to clarify the relation between ER and VF in patients with VSA and to investigate the long-term outcomes of ICD therapy.
  
  
  RESULTS
  This retrospective, observational survey evaluated 265 consecutive VSA patients, including 21 with VF. Their electrocardiogram findings and clinical course were analysed over a mean follow-up of 5.5 ± 3.3 years. Early repolarization was observed in 64 patients (24.2%) and was more frequent in patients with VF history than those without (P = 0.001). Early repolarization was independently associated with VF history. During follow-up, four patients had VF recurrences. Ventricular fibrillation recurrence was higher in patients with ER (log-rank, P = 0.018) or VF history (log-rank, P < 0.001) than those without. Among patients with ER, day-to-day variations in ER (P = 0.003) and notching of ER pattern (P = 0.03) were associated with VF history. Cases with day-to-day variation showed a higher incidence of VF recurrence during follow-up (log-rank, P = 0.007). During long-term follow-up, 23.5% of patients with an ICD received appropriate shock therapy.
  
  
  CONCLUSIONS
  The presence of ER, especially with day-to-day variation, can help predict VF recurrence in VSA patients. Implantable cardioverter defibrillator implantation is a reasonable approach for the secondary prevention of VF in high-risk VSA patients.
authors.affiliation: Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu, Shibuya-ku, Tokyo, Japan take1124@hotmail.co.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kitamura
authors.affiliation: Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu, Shibuya-ku, Tokyo, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Fukamizu
authors.affiliation: Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu, Shibuya-ku, Tokyo, Japan.
authors.forename: Rintaro
authors.initials: R
authors.lastname: Hojo
authors.affiliation: Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu, Shibuya-ku, Tokyo, Japan.
authors.forename: Yuya
authors.initials: Y
authors.lastname: Aoyama
authors.affiliation: Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu, Shibuya-ku, Tokyo, Japan.
authors.forename: Kota
authors.initials: K
authors.lastname: Komiyama
authors.affiliation: Department of Cardiology, Yokohama Minami Kyosai Hospital, Yokohama, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Nishizaki
authors.affiliation: Tokyo Metropolitan Health and Medical Treatment Corporation Ohkubo Hospital, Tokyo, Japan.
authors.forename: Harumizu
authors.initials: H
authors.lastname: Sakurada
authors.affiliation: Tokyo Medical and Dental University, Tokyo, Japan Toride Kitasoma Medical Center Hospital, Ibaraki, Japan.
authors.forename: Masayasu
authors.initials: M
authors.lastname: Hiraoka
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000150:complications* / Q000000981:diagnostic imaging; D017023:Coronary Angiography; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D014693:Ventricular Fibrillation / Q000628:therapy*
keywords: Early repolarization; Implantable cardioverter defibrillator; Sudden cardiac death; Vasospastic angina; Ventricular fibrillation