This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Chevalier, D. P. Articles by Wellens, H. J. J. Search for Related Content PubMed PubMed Citation Articles by Chevalier, D. P. Articles by Wellens, H. J. J.

(Circulation. 1999;100:e140.)
© 1999 American Heart Association, Inc.

Circulation Electronic Pages

Calcium-Channel Blockers and Cardiac Arrest

Dr Philippe Chevalier; Dr Paul Touboul

Hôpital Cardio-vasculaire et Pneumologique, Lyon, France

	Introduction

 
To the Editor:

We would like to compliment Zipes and Wellens on their excellent article about sudden cardiac death, which was recently published in Circulation.¹ We think, however, that calcium channel blockers deserve a mention in this review as a potential treatment for patients who are resuscitated from cardiac arrest. Isolated coronary spasm without associated coronary obstruction can occasionally trigger lethal ventricular arrhythmias. It has, therefore, been recommended that the ergonovine test be performed in any patient who has been resuscitated from cardiac arrest in whom no structural heart disease can be found.² In a few reports, treatment with calcium blockers, with or without nitrates, seems to give a good prognosis.^{3 4} For instance, in a study by Myerburg et al,³ treatment with calcium-channel blockers was successful in preventing ventricular arrhythmias in patients with previous cardiac arrest and a positive ergonovine test.

We recently reviewed our experience with 7 patients who suffered an arrhythmic cardiac arrest due to coronary artery spasm that was not associated with significant coronary artery narrowing.⁵ All patients underwent an ergonovine provocation test, and the dose of their treatment with calcium-channel blockers was determined by titrating the dose until a negative test result was obtained. After a mean follow-up period of 58 months, 6 patients remained symptom-free; 1 patient who had not stopped smoking had another cardiac arrest, despite treatment for coronary spasm. Without this strategy, our patients would have unnecessarily had an automatic defibrillator implanted. This topic also clearly demonstrates how patients who have a . . . [Full Text of this Article]

Douglas P. Zipes, MD; Hein J. J. Wellens, MD

Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Ind