title: Long-term prognosis of patients with life-threatening ventricular arrhythmias induced by coronary artery spasm.
abstract: Coronary artery spasm (CAS) is associated with ventricular arrhythmias (VA). Much controversy remains regarding the best therapeutic interventions for this specific patient subset. We aimed to evaluate the clinical outcomes of patients with a history of life-threatening VA due to CAS with various medical interventions, as well as the need for ICD placement in the setting of optimal medical therapy.
  
  
  
  A multicentre European retrospective survey of patients with VA in the setting of CAS was aggregated and relevant clinical and demographic data was analysed. Forty-nine appropriate patients were identified: 43 (87.8%) presented with VF and 6 (12.2%) with rapid VT. ICD implantation was performed in 44 (89.8%). During follow-up [59 (17-117) months], appropriate ICD shocks were documented in 12. In 8/12 (66.6%) no more ICD therapies were recorded after optimizing calcium channel blocker (CCB) therapy. SCD occurred in one patient without ICD. Treatment with beta-blockers was predictive of appropriate device discharge. Conversely, non-dihydropyridine CCB therapy was significantly protective against VAs.
  
  
  
  Patients with life-threatening VAs secondary to CAS are at particularly high-risk for recurrence, especially when insufficient medical therapy is administered. Non-dihydropyridine CCBs are capable of suppressing episodes, whereas beta-blocker treatment is predictive of VAs. Ultimately, in spite of medical intervention, some patients exhibited arrhythmogenic events in the long-term, suggesting that ICD implantation may still be indicated for all.
authors.affiliation: Cardiology Department, Complejo Hospital Universitario Santiago de Compostela, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Santiago de Compostela, Spain.
authors.forename: Moisés
authors.initials: M
authors.lastname: Rodríguez-Mañero
authors.affiliation: Electrophysiology Unit, Cardiology Service, Hospital Miguel Servet Zaragoza, Zaragoza, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Oloriz
authors.affiliation: Cliniques universitaire Saint-Luc, Université de Louvain, Brussels.
authors.forename: Jean-Benoit
authors.initials: JB
authors.lastname: le Polain de Waroux
authors.affiliation: Electrophysiology Unit, Cardiology Service, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Haran
authors.initials: H
authors.lastname: Burri
authors.affiliation: Cardiology Department, Complejo Hospital Universitario Santiago de Compostela, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Santiago de Compostela, Spain.
authors.forename: Bahij
authors.initials: B
authors.lastname: Kreidieh
authors.affiliation: Vrije Universiteit Brussel, Electrophysiology Unit, Brussels, Belgium.
authors.forename: Carlos
authors.initials: C
authors.lastname: de Asmundis
authors.affiliation: Electrophysiology Unit, Cardiology Service, Hospital Virgen de la Salud, Toledo, Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Arias
authors.affiliation: Electrophysiology Unit, Cardiology Service, Hospital Clinic Barcelona, Barcelona, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Arbelo
authors.affiliation: Cardiology Department, Complejo Hospital Universitario Santiago de Compostela, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Santiago de Compostela, Spain.
authors.forename: Brais
authors.initials: B
authors.lastname: Díaz Fernández
authors.affiliation: Electrophysiology Unit, Cardiology Service, Hospital Puerta del Mar, Cádiz, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Fernández-Armenta
authors.affiliation: Electrophysiology Unit, Cardiology Service, Hospital Universitario La Fe, Valencia, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Basterra
authors.affiliation: Electrophysiology Unit, Cardiology Service, Hospital Clínico Universitario de Valencia, Valencia, Spain.
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Izquierdo
authors.affiliation: Electrophysiology Unit, Cardiology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Díaz-Infante
authors.affiliation: Electrophysiology Unit, Cardiology Service, Clínica Universidad de Navarra, Pamplona. Navarra, Spain.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Ballesteros
authors.affiliation: Coronary and Intensive Care Unit, University Hospital Son Espases, Palma de Mallorca, Spain.
authors.forename: Andrés
authors.initials: A
authors.lastname: Carrillo López
authors.affiliation: Coronary and Intensive Care Unit, University Hospital Son Espases, Palma de Mallorca, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: García-Bolao
authors.affiliation: Electrophysiology Unit, Cardiology Service, Hospital Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Benezet-Mazuecos
authors.affiliation: Electrophysiology Unit, Cardiology Service, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
authors.forename: Victor
authors.initials: V
authors.lastname: Expósito-García
authors.affiliation: Electrophysiology Unit, Cardiology Service, Hospital Universitario de Basurto, Bilbao, Spain.
authors.lastname: Larraitz-Gaztañaga
authors.affiliation: Cardiology Department, Complejo Hospital Universitario Santiago de Compostela, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Santiago de Compostela, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Martínez-Sande
authors.affiliation: Cardiology Department, Complejo Hospital Universitario Santiago de Compostela, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Santiago de Compostela, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: García-Seara
authors.affiliation: Cardiology Department, Complejo Hospital Universitario Santiago de Compostela, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Santiago de Compostela, Spain.
authors.forename: Jose Ramón
authors.initials: JR
authors.lastname: González-Juanatey
authors.affiliation: Electrophysiology Unit, Cardiology Service, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Peinado
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D003329:Coronary Vasospasm / Q000150:complications / Q000188:drug therapy; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D000069451:Long Term Adverse Effects / Q000175:diagnosis / Q000517:prevention & control; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D055502:Secondary Prevention / Q000379:methods; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy
chemical_list: D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers