[Syncope with cardiac arrest in a 30-year-old woman].

HISTORY AND ADMISSION FINDINGS: A 30-year-old woman presented with a cardiac arrest, which spontaneously converted into a regular sinus rhythm. The patient had no prior history of cardiovascular diseases. On admission, the cardiovascular clinical examination of this young female was regular.

INVESTIGATIONS: On admission, discrete inferior repolarisation changes were documented which were slightly progressive during the next day. Electrophysiologic examination of the heart was regular, angiography showed a coronary fistula and an atypical descense of the circumflex artery from the right coronary artery.

DIAGNOSIS: Right coronary artery fistula to the right ventricle. Atypical descense of the circumflex artery from the right coronary artery.

TREATMENT AND COURSE: During hospitalisation no arrhythmias or pauses were revealed. The patient underwent cardiac pacemaker implantation. We plan a transcatheter closure of the fistula.

CONCLUSIONS

Coronary fistulas are a rare cause of cardiac arrhythmias. Angiography performed at an early stage is therefore crucial in the initial assessment of a young adult presenting with cardiac arrest and subsequent changes in the ECG, as a small proportion may have coronary vascular abnormalities. The occlusion of the fistula by transcatheter or cardiac surgery is appropriate, especially as the risks of the interventions are limited.