Early repolarization pattern and its day-to-day dynamic change as markers for ventricular fibrillation in patients with vasospastic angina

• Published in: Europace (London, England) Vol. 18; no. 8; pp. 1252 - 1258
• Main Authors: Kitamura, Takeshi, Fukamizu, Seiji, Hojo, Rintaro, Aoyama, Yuya, Komiyama, Kota, Nishizaki, Mitsuhiro, Sakurada, Harumizu, Hiraoka, Masayasu
• Format: Journal Article
• Language: English
• Published: England 01.08.2016
• Subjects: Aged; Angina Pectoris - complications; Angina Pectoris - diagnostic imaging; Coronary Angiography; Death, Sudden, Cardiac - prevention & control; Defibrillators, Implantable; Electrocardiography; Female; Humans; Japan; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Recurrence; Retrospective Studies; Risk Factors; Secondary Prevention; Ventricular Fibrillation - therapy; Vasospastic angina; Early repolarization; Sudden cardiac death; Implantable cardioverter defibrillator; Ventricular fibrillation
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/euv281

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. 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. 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.