VENTRICULAR-FIBRILLATION RELATED TO CORONARY SPASM IN PATIENTS WITHOUT SIGNIFICANT CORONARY OR OTHER STRUCTURAL HEART-DISEASE

We present three patients without significant coronary or other struct ural heart disease who were resuscitated after ventricular fibrillatio n attributed to coronary spasm. Angina pectoris was present in two of the cases and silent myocardial ischemia in the third. All patients we re given calcium antagonists at discharge. A defibrillator was also im planted in the patient with silent myocardial ischemia because further episodes of ischemia would probably have occurred without premonitory symptoms. Coronary spasm might be a mechanism of ventricular fibrilla tion in patients without significant structural heart disease. Diagnos tic tests should therefore be performed to confirm or exclude coronary spasm in such cases. The implantation of an automatic defibrillator s eems justified in selected patients with documented coronary spasm, si lent myocardial ischemia, and associated sustained ventricular tachyar rhythmia, although prospective studies are not yet available.