This protocol addresses patients with variant angina who experience cardiac arrest or syncope caused by ventricular tachycardia or ventricular fibrillation. The defining feature is that the arrhythmia arises in the context of coronary artery spasm that is either refractory or not adequately controlled by medical therapy.
In patients in whom cardiac arrest or syncope occurs due to VT/VF during periods of refractory coronary artery spasm — or where spasm persists despite optimal medical management, including as demonstrated by provocation testing — the arrhythmic risk is substantial and ongoing. Standard vasodilator therapy alone may be insufficient to prevent recurrence.
The structured protocol for this scenario involves a device-based intervention targeting the risk of life-threatening arrhythmia recurrence. The full protocol specifies the indication, procedural considerations, and supporting evidence.
DOI: 10.15420/ecr.2022.47
In patients with syncope or cardiac arrest caused by CAS-related tachyarrhythmias, or even bradyarrhythmias, implantation of an ICD or pacemaker, respectively, should be considered according to the risk of recurrence and efficacy of vasodilator therapy.
Conversely, in patients in whom cardiac arrest occurs due to ventricular tachycardia/VF in the context of periods of refractory CAS or with CAS not well controlled by medical therapy (as indicated by the induction of CAS by provocation tests under optimal medical therapy), an ICD can be life saving and should therefore be implanted.
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