Copyright © 1998 by the European Society of Cardiology.
Low prevalence of coronary artery spasm in patients with normal coronary angiograms and unexplained ventricular fibrillation
Department of Cardiology, Heart–Lung Institute, University Hospital Utrecht, Utrecht, The Netherlands
accepted January 12, 1998
Aims
The aetiology of ventricular fibrillation in patients without identifiable structural heart disease is unknown. Recently, a high prevalence of silent ischaemia due to coronary artery spasm has been reported in such patients. However, in at least one report, all patients had non-critical coronary artery lesions. Identification of coronary artery spasm as the underlying aetiology of ventricular fibrillation has important therapeutic implications.
Methods and Results
We performed ergonovine provocation tests in 18 patients (14 males, and four females; mean age, 36 years) with documented ventricular fibrillation in the absence of identifiable structural heart disease who had undergone aborted sudden death. In group I (n=7) ergo-novine provocation tests were performed at a mean interval of 31 months (range 21–42 months) after the index episode. These patients had already received an implantable cardioverter defibrillator, after failed electrophysiologically guided antiarrhythmic therapy. In group II (n=11) the ergonovine provocation test was performed prospectively as part of the diagnostic evaluation. All patients were off antiarrhythmic drugs, calcium entry or beta-adrenoceptor blockers at the time of the ergonovine provocation test. Ergonovine was administered intravenously as a bolus injection, beginning with 0·05mg followed every 3min by incremental doses up to a cumulative maximum dose of 0·45mg. Predefined end-points were: (1) recording of ischaemic ST segment shifts of 
1mm in at least two corresponding leads of the 12-lead electrocardiogram; (2) induction of ventricular tachycardia or ventricular fibrillation; and (3) administration of a cumulative dose of 0·45mg. A positive response to ergonovine was seen in only one patient (5%) in group I in whom there developed ST segment elevation without angina and a short burst of rapid ventricular tachycardia.
Conclusions
This study found a low prevalence of coronary artery spasm in patients with aborted sudden death resulting from documented ventricular fibrillation and non-apparent underlying heart disease. All patients had normal coronary angiograms and a negative history for spontaneous episodes of chest pain. The mechanism of arrhythmogenesis in such patients remains largely unknown.
Key Words: Vasospasm • death • sudden • fibrillation • ergonovine testing.
f1 Correspondence: René H. J. Peters, MD, Department of Cardiology, Heart–Lung Institute, University Hospital Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands.
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