Abstract 13389: Usefulness of Dual Induction Tests for Coronary Vasospasm and Ventricular Fibrillation for Individualized Treatment of Survivors from Out-of-Hospital Cardiac Arrest without Structural Heart Disease
Backgrounds: The progress in critical care has revealed that the prevalence of cardiac arrest without structural heart disease is high than previously reported. It is important to precisely diagnose the cause of out-of-hospital cardiac arrest (OHCA) in each survivor. Since both coronary vasospasm and idiopathic ventricular fibrillation (VF) may be involved in the pathogenesis of OHCA, we examined the usefulness of the dual induction tests for the disorders.
Methods and Results: We examined 20 consecutive OHCA survivors without organic heart disease who showed VF as an initial rhythm (male/female, 19/1; 44±13 [SD] years) between December 2004 and May 2010. They had normal left ventricular ejection fraction (66±7%) and underwent the dual induction tests for coronary vasospasm with intracoronary acetylcholine and VF with EPS. Importantly, all patients were positive for either test; coronary vasospasm alone in 3, VF alone in 5, and both of them in 12. All patients subsequently underwent implantable cardioverter defibrillator (ICD) implantation and 15 patients with coronary vasospasm were also treated with calcium channel blockers (CCBs). During the 23±17 months follow-up period, appropriate ICD shocks were documented in 4 patients with both coronary spasm and VF and in 1 patient with VF alone, whereas no VF was documented in patients with coronary vasospasm alone under CCBs treatment. Overall VF-free survival rate in patients with EPS-induced VF (with and without coronary vasospasm) was 69% at 1 year and 58% at 2 year (Figure). Importantly, the sensitivity and the negative predictive value of EPS for predicting recurrence of VF were 100% and 100%, respectively.
Conclusions: These results indicate that the etiology of OHCA is heterogeneous and that the dual induction tests for coronary vasospasm and VF are useful for individualized treatment for OHCA survivors without organic heart disease.
- Cardiac arrest
- Coronary vasospasm
- Ventricular fibrillation
- Implantable cardioconvert defibrillator
- © 2010 by American Heart Association, Inc.