title: Usefulness of Testing for Coronary Artery Spasm and Programmed Ventricular Stimulation in Survivors of Out-of-Hospital Cardiac Arrest.
abstract: Optimal therapy for patients resuscitated from out-of-hospital cardiac arrest (OHCA) who are not found to have structural heart disease remains to be established, especially regarding the use of implantable cardioverter-defibrillators. Coronary artery spasm (CAS) and lethal ventricular arrhythmias are important causes of OHCA.
  
  
  
  In 47 consecutive OHCA survivors without structural heart disease who had fully recovered (M/F 44/3, 43±13 years.), we performed dual induction tests, including acetylcholine provocation test first followed by programmed ventricular stimulation after 1 to 2 weeks. Patients with CAS were treated with calcium channel blocker-based antianginal medications; implantable cardioverter-defibrillators were implanted in all patients. The results of the dual induction tests defined 4 groups: CAS alone (n=7), inducible ventricular arrhythmias alone (n=13), both positive (n=24), and both negative (n=3). During a median follow-up period of 38 months, ventricular fibrillation recurred in all groups except the both-negative group. Of the 16 patients with a type I Brugada ECG, 2 had CAS alone, 8 had ventricular arrhythmias alone, and 6 had both positive. No ventricular fibrillation episodes were observed in the CAS-alone patients who did not also have Brugada syndrome. Kaplan-Meier analysis showed that the CAS-alone group was at lower risk for OHCA recurrence as compared with the Brugada syndrome group (log-rank test; P=0.036).
  
  
  
  Among OHCA survivors without structural heart disease, provokable CAS and ventricular arrhythmias are common and can be seen in Brugada syndrome. CAS alone without Brugada syndrome who are treated for CAS may be a lower-risk group.
authors: From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors: Masayasu
authors: M
authors: Komatsu
authors: From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors: Jun
authors: J
authors: Takahashi
authors: From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors: Koji
authors: K
authors: Fukuda
authors: From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors: Yusuke
authors: Y
authors: Takagi
authors: From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors: Takashi
authors: T
authors: Shiroto
authors: From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors: Makoto
authors: M
authors: Nakano
authors: From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors: Masateru
authors: M
authors: Kondo
authors: From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors: Ryuji
authors: R
authors: Tsuburaya
authors: From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors: Kiyotaka
authors: K
authors: Hao
authors: From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors: Kensuke
authors: K
authors: Nishimiya
authors: From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors: Taro
authors: T
authors: Nihei
authors: From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors: Yasuharu
authors: Y
authors: Matsumoto
authors: From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors: Kenta
authors: K
authors: Ito
authors: From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors: Yasuhiko
authors: Y
authors: Sakata
authors: From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors: Satoshi
authors: S
authors: Miyata
authors: From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan. shimo@cardio.med.tohoku.ac.jp.
authors: Hiroaki
authors: H
authors: Shimokawa
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D053840:Brugada Syndrome / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D003329:Coronary Vasospasm / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D017741:Survivors
keywords: angina; arrhythmia; heart arrest; vasospasm