Outcomes of Brugada Syndrome Patients with Coronary Artery Vasospasm

Abstract

Objective To evaluate the outcomes of patients with concomitant Brugada syndrome and coronary artery vasospasm. Methods Patients diagnosed with Brugada syndrome with an implantable cardiac defibrillator were retrospectively investigated, and the coexistence of vasospasm was evaluated. The clinical features and outcomes were evaluated, especially in patients with coexistent vasospasm. A provocation test using acetylcholine was performed in patients confirmed to have no organic stenosis on percutaneous coronary angiography to confirm the presence of vasospasm. Implantable cardiac defibrillator shock status was checked every three months. Statistical comparisons of the groups with and without vasospasm were performed. A univariate analysis was also performed, and the odds ratio for the risk of implantable cardiac defibrillator shock was calculated. Patients Thirty-five patients with Brugada syndrome, of whom six had coexistent vasospasm. Results There were no significant differences in the laboratory data, echocardiogram findings, disease, or the history of taking any drugs between patients with and without vasospasm. There were significant differences in the clinical features of Brugada syndrome, i.e. cardiac events such as resuscitation from ventricular fibrillation or appropriate implantable cardiac defibrillator shock. Four patients with vasospasm had cardiac events such as resuscitation from ventricular fibrillation and/or appropriate defibrillator shock; three of them had no cardiac events with calcium channel blocker therapy to prevent vasospasm. The coexistence of vasospasm was a potential risk factor for an appropriate implantable cardiac defibrillator shock (odds ratio: 13.5, confidence interval: 1.572-115.940, p value: 0.035) on a univariate analysis. Conclusion Coronary artery vasospasm could be a risk factor for cardiac events in patients with Brugada syndrome.

Figure 1.

A 29-year-old healthy man. The electrocardiogram on admission shows the spontaneous type-1 pattern. The marked type-1 pattern manifests during provocation with pilsicainide and while right coronary artery spasm appears.

Figure 2.

A 33-year-old healthy man. The electrocardiogram on admission is normal. The electrocardiogram during right coronary artery spasm is also normal. However, the marked type-1 pattern manifests only after provocation with pilsicainide.

Figure 3.

A 34-year-old healthy man. The electrocardiogram on admission shows Brugada syndrome-like change. The marked type-1 pattern manifests after provocation with pilsicainide and while right coronary artery spasm appears.

Figure 4.

A 35-year-old healthy man. The electrocardiogram on admission and during right coronary artery spasm shows Brugada syndrome-like change but does not meet the criteria for Brugada syndrome. The marked type-1 pattern manifests only after provocation with pilsicainide.

Figure 5.

A 35-year-old healthy man. The electrocardiogram on admission shows Brugada syndrome-like change but does not meet the criteria for Brugada syndrome. The marked type-1 pattern manifests after provocation with pilsicainide and while right coronary artery spasm appears.