Case Report: Recurrent ventricular fibrillation induced by multivessel coronary artery spasm: a case supporting ICD for secondary prevention.

BACKGROUND

Coronary artery spasm (CAS), also known as vasospastic angina, is a functional coronary disorder that can precipitate transient myocardial ischemia and life-threatening ventricular arrhythmias. Although generally reversible, severe or multivessel CAS may lead to sudden cardiac death, and its optimal management remains controversial.

CASE PRESENTATION: We report a case of a 71-year-old man of Chinese ethnicity with a history of atrial fibrillation ablation and chronic obstructive pulmonary disease who presented with recurrent episodes of chest discomfort followed by sudden cardiac arrest. The patient experienced multiple episodes of ventricular tachycardia and ventricular fibrillation requiring repeated defibrillation and advanced cardiopulmonary resuscitation. Initial coronary angiography showed no significant fixed coronary stenosis. However, during recurrent ischemic episodes accompanied by dynamic ST-segment elevation, emergent repeat angiography demonstrated severe multivessel coronary spasm, including near-total occlusion of the mid left anterior descending artery and complete occlusion of the distal right coronary artery. Intracoronary nitrate administration promptly relieved the spasm and restored coronary flow. Despite intensive medical therapy with calcium channel blockers and nitrates and withdrawal of potential triggering agents, the patient suffered recurrent malignant ventricular arrhythmias. He ultimately underwent implantable cardioverter-defibrillator (ICD) implantation for secondary prevention. No ICD therapies were recorded during follow-up.

CONCLUSION

This case highlights that multivessel coronary artery spasm can provoke recurrent malignant ventricular arrhythmias even in the absence of fixed coronary stenosis. In patients with CAS complicated by recurrent ventricular fibrillation despite optimal medical therapy, ICD implantation may be a reasonable strategy for secondary prevention of sudden cardiac death.