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Life-threatening ventricular arrhythmias after resuscitated from aborted sudden cardiac death (ASCD) in patients with pure vasospastic angina (VSA) are a serious major problem in the clinic . Under the sufficient medical therapy including multiple vasodilators, the majority of VSA has a favorable clinical outcome, whereas patients with ASCD due to pure coronary artery spasm may have an adverse prognosis . Implantable cardioverter-defibrillator (ICD) was effective in patients with structural heart disease and ventricular fibrillation/tachycardia 6, . The majority of clinical reports concluded that the implantation of ICD was effective to suppress the next fatal events in patients with ASCD due to coronary artery spasm . However, just one-quarter patients with ASCD due to coronary artery spasm after the implantation of ICD had appropriate ICD shocks during the follow-up periods . Manero et al reported that the frequency of appropriate ICD shocks was 24.5% (12/49) in patients with ASCD due to coronary artery spasm after the implantation of ICD during follow-up of 59 months . We had no precise definition of which ASCD patients due to coronary spasm should be necessary to implant the ICD to suppress the next fatal serious arrhythmic events. In this review, I mentioned the optimal medications and mechanical therapy in patients with ASCD due to pure coronary spasm and I also described the necessity of spasm provocation testing under the sufficient medications as well as the implantation of ICD.

Optimal Medical or Mechanical Treatment for Patients with Aborted Sudden Cardiac Death due to Coronary Spasm