Early repolarization and positive T-wave alternans as risk markers for life-threatening arrhythmias in patients with vasospastic angina

Background: Several arrhythmogenic markers have been suggested as predictors for risk of life-threatening arrhythmias during symptom-free periods in vasospastic angina (VSA), but no definite conclusion has been drawn. Objective: To investigate prevalence of fatal ventricular tachyarrhythmia in VSA and its relation to appearance of early repolarization (ER) and positive T wave alternans (p-TWA) in patients with VSA during symptom-free periods. Methods: We studied 116 consecutive patients with chest pain who underwent an acetylcholine provocation test for VSA diagnosis. Patients were divided into two groups with positive (VSA group; 66 cases) and negative (control group; 50 cases) provocation test results. The presence of ER on electrocardiogram and the modified moving average analysis of TWA during symptom-free periods were explored. Results: The incidences of ER and p-TWA were higher in the VSA than in the control group (P = 0.001 and P = 0.006, respectively). Multivariate analysis revealed that ER and p-TWA were independent predictors of VSA (odds ratio, 5.65 and 4.94; 95% confidence interval: 1.11-28.9 and 1.22-19.9, respectively). The incidence of coexisting baseline ER and p-TWA was significantly higher in VSA patients with life-threatening arrhythmic events (3/3 vs. 6/38; P < 0.001) than in those without. Conclusions: VSA patientswith arrhythmic events showed a high incidence of ER and p-TWA during symptom-free periods. Therefore, baseline ER and p-TWA may help to identify VSA patients at high risk for life-threatening arrhythmias. (C) 2015 Elsevier Ireland Ltd. All rights reserved.