Implantable Cardioverter Defibrillator Versus Optimal Medical Therapy In Patients With Variant Angina Manifesting as Aborted Sudden Cardiac Death

Prior treatment

• prior history of atrial or ventricular arrhythmia requiring class I or III antiarrhythmic drugs (flecainide, propafenone, amiodarone, sotalol and dronedarone)
• Prior catheter ablation for ventricular arrhythmia
• Prior pacemaker or Implantable Cardioverter Defibrillator

Other illness

• Chronic Heart Failure New York Heart Association functional class III or IV
• Psychiatric illnesses that may be aggravated by device implantation or that may preclude systematic follow-up

Lab values

• Organic heart disease known to be associated with sudden cardiac arrest.
  • Heart failure with reduced ejection fraction (Left Ventricular Ejection Fraction \< 35%)
  • Presence of LV akinesia or aneurysm
  • Hypertrophic cardiomyopathy
  • Arrhythmogenic right ventricular dysplasia
• Primary cardiac electrical diseases (long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia)

Age

• Life expectancy \<2 years

Other

• Significant (\>50%) coronary artery stenosis on coronary angiography
• 2nd or 3rd degree AV block not related to coronary ischemia, requiring permanent pacemaker
• Patients with poor neurologic outcome (defined as cerebral performance category scale ≥3)

• Age 18 years or older
• Patients experienced successfully resuscitated cardiac arrest due to documented ventricular fibrillation or sustained rapid ventricular tachycardia
• Diagnosed as variant angina, defined by spontaneous coronary spasm with ST elevation (≥0.1mV) in the coronary angiogram and/or documented coronary spasm on ergonovine provocation coronary angiography