Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan.
J Am Heart Assoc. 2018 Feb 7;7(4):e007942. doi: 10.1161/JAHA.117.007942.
Previously described patients with early repolarization syndrome (ERS) may have experienced silent coronary artery spasm (CAS) because the diagnosis of CAS was mainly based on symptoms or coronary angiography findings, without performing a spasm provocation test. This study investigated the significance of CAS diagnosis and evaluated the incidence of silent CAS in patients with possible ERS (ie, idiopathic ventricular fibrillation [VF] and inferolateral J wave).
The study included 34 patients with idiopathic VF and inferolateral J wave. Thirteen patients (38%) were diagnosed as having CAS on the basis of coronary angiography with spasm provocation test (n=8) and documentation of spontaneous ST elevation (n=5). Of the 13 patients with CAS, 5 (38%) did not experience chest symptoms before and during VF, and were diagnosed as having silent CAS. The remaining 21 patients (62%), with a negative provocation test result and absence of chest symptoms, were considered to have ERS. During the 92 months of follow-up, patients with CAS receiving appropriate medical treatment with antianginal drugs showed a favorable outcome. In contrast, 4 of 21 patients with ERS (19%) had VF recurrences. The use of monotherapy or combination therapy, consisting of quinidine, cilostazol, and bepridil, in the 4 patients with ERS, was effective in suppressing VF.
Approximately 40% of patients with CAS with documented VF and inferolateral J wave did not experience chest symptoms at the first VF, and could have been misdiagnosed as having ERS. The use of the spasm provocation test is considered essential to differentiate patients for optimal medical treatment.
先前描述的早期复极综合征（ERS）患者可能经历过无症状性冠状动脉痉挛（CAS），因为 CAS 的诊断主要基于症状或冠状动脉造影结果，而没有进行痉挛激发试验。本研究旨在探讨 CAS 诊断的意义，并评估可能的 ERS 患者（即特发性心室颤动[VF]和下外侧 J 波）中无症状性 CAS 的发生率。
该研究纳入了 34 例特发性 VF 和下外侧 J 波患者。13 例患者（38%）基于冠状动脉造影和痉挛激发试验（n=8）及自发 ST 段抬高的记录（n=5）被诊断为 CAS。在 13 例有 CAS 的患者中，5 例（38%）在 VF 发生前和期间没有胸痛症状，被诊断为无症状性 CAS。其余 21 例（62%）患者激发试验结果为阴性且无胸痛症状，被认为患有 ERS。在 92 个月的随访期间，接受抗心绞痛药物等适当治疗的 CAS 患者预后良好。相比之下，21 例 ERS 患者中有 4 例（19%）发生 VF 复发。在这 4 例 ERS 患者中，使用奎尼丁、西洛他唑和贝普地尔的单药或联合治疗对抑制 VF 有效。
大约 40%的有记录的 VF 和下外侧 J 波的 CAS 患者在首次 VF 时没有胸痛症状，可能被误诊为 ERS。痉挛激发试验的应用被认为是区分患者并进行最佳药物治疗的必要手段。
