The Korean journal of internal medicine

  • 제32권5호
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  • Pages.836-846
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  • 2017
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  • 1226-3303(pISSN)
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  • 2005-6648(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
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Masked inherited primary arrhythmia syndromes in sudden cardiac death patients accompanied by coronary vasospasm

  • Lee, Ki Hong (Department of Cardiovascular Medicine, Chonnam National University Hospital) ;
  • Park, Hyung Wook (Department of Cardiovascular Medicine, Chonnam National University Hospital) ;
  • Eun, Jeong Nam (Department of Cardiovascular Medicine, Chonnam National University Hospital) ;
  • Cho, Jeong Gwan (Department of Cardiovascular Medicine, Chonnam National University Hospital) ;
  • Yoon, Nam Sik (Department of Cardiovascular Medicine, Chonnam National University Hospital) ;
  • Kim, Mi Ran (Department of Nursing, Chunnam Techno University) ;
  • Ku, Yo Han (Department of Cardiovascular Medicine, Chonnam National University Hospital) ;
  • Park, Hyukjin (Department of Cardiovascular Medicine, Chonnam National University Hospital) ;
  • Lee, Seung Hun (Department of Cardiovascular Medicine, Chonnam National University Hospital) ;
  • Kim, Jeong Han (Department of Cardiovascular Medicine, Chonnam National University Hospital) ;
  • Kim, Min Chul (Department of Cardiovascular Medicine, Chonnam National University Hospital) ;
  • Kim, Woo Jin (Department of Cardiovascular Medicine, Chonnam National University Hospital) ;
  • Kim, Hyun Kuk (Department of Cardiovascular Medicine, Chonnam National University Hospital) ;
  • Cho, Jae Yeong (Department of Cardiovascular Medicine, Chonnam National University Hospital) ;
  • Park, Keun-Ho (Department of Cardiovascular Medicine, Chonnam National University Hospital) ;
  • Sim, Doo Sun (Department of Cardiovascular Medicine, Chonnam National University Hospital) ;
  • Yoon, Hyun Ju (Department of Cardiovascular Medicine, Chonnam National University Hospital) ;
  • Kim, Kye Hun (Department of Cardiovascular Medicine, Chonnam National University Hospital) ;
  • Hong, Young Joon (Department of Cardiovascular Medicine, Chonnam National University Hospital) ;
  • Kim, Ju Han (Department of Cardiovascular Medicine, Chonnam National University Hospital) ;
  • Ahn, Youngkeun (Department of Cardiovascular Medicine, Chonnam National University Hospital) ;
  • Jeong, Myung Ho (Department of Cardiovascular Medicine, Chonnam National University Hospital) ;
  • Park, Jong Chun (Department of Cardiovascular Medicine, Chonnam National University Hospital)
  • 투고 : 2015.08.20
  • 심사 : 2015.12.06
  • 발행 : 2017.09.01
⟨ 이전 논문 다음 논문 ⟩

초록

Background/Aims: Coronary vasospasms are one of the important causes of sudden cardiac death (SCD). Provocation of coronary vasospasms can be useful, though some results may lead to false positives, with patients potentially experiencing recurrent SCD despite appropriate medical treatments. We hypothesized that it is not coronary vasospasms but inherited primary arrhythmia syndromes (IPAS) that underlie the development of SCD. Methods: We analyzed 74 consecutive patients (3.8%) who survived out-of-hospital cardiac arrest among 1,986 patients who had angiographically proven coronary vasospasms. Electrical abnormalities were evaluated in serial follow-up electrocardiograms (ECGs) during and after the index event for a 3.9 years median follow-up. Major clinical events were defined as the composite of death and recurrent SCD events. Results: Forty five patients (60.8%) displayed electrocardiographic abnormalities suggesting IPAS: Brugada type patterns in six (8.2%), arrhythmogenic right ventricular dysplasia patterns in three (4.1%), long QT syndrome pattern in one (2.2%), and early repolarization in 38 (51.4%). Patients having major clinical events showed more frequent Brugada type patterns, early repolarization, and more diffuse multivessel coronary vasospasms. Brugada type pattern ECGs (adjusted hazard ratio [HR], 4.22; 95% confidence interval [CI], 1.16 to 15.99; p = 0.034), and early repolarization (HR, 2.97; 95% CI, 1.09 to 8.10; p = 0.034) were ultimately associated with an increased risk of mortality. Conclusions: Even though a number of aborted SCD survivors have coronary vasospasms, some also have IPAS, which has the potential to cause SCD. Therefore, meticulous evaluations and follow-ups for IPAS are required in those patients.

키워드

과제정보

연구 과제 주관 기관 : The Korea Centers for Disease Control and Prevention, Ministry of Health and Welfare

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피인용 문헌

  1. Can documented coronary vasospasm be the smoking gun in settling the etiology of sudden cardiac death? vol.32, pp.5, 2017, https://doi.org/10.3904/kjim.2017.283
  2. Symptomatic Long QT Syndrome Coexisting with Asymptomatic Acetylcholine-induced Vasospasm vol.60, pp.13, 2017, https://doi.org/10.2169/internalmedicine.6475-20
  3. Inherited arrhythmia syndrome predisposing to sudden cardiac death vol.36, pp.3, 2017, https://doi.org/10.3904/kjim.2020.481