Refractory Vasospastic Angina and Sudden Cardiac Arrest: Is Implantable Cardioverter Defibrillator Indicated and Is It Always Protective?

Vasospastic angina (VSA) is characterized by episodic chest pain associated with transient ST-segment abnormalities on electrocardiogram, secondary to vasospasm of the epicardial coronary artery. We report the rare case of a 46-year-old female with refractory VSA secondary to multivessel coronary vasospasm causing an anterior myocardial infarction. She succumbed secondary to ventricular tachycardia (VT) storm, in spite of being on maximally tolerated medical therapy and having an implantable cardioverter defibrillator (ICD) for secondary prevention of VT. Contemporary guidelines recommend ICD implantation (class IIa) in VSA patients who survived sudden cardiac arrest (SCA), if they are already on optimal medical therapy or if medical therapy is not tolerated. Whether ICD implantation is appropriate in VSA patients with aborted SCA, even before assessing the response to medical therapy, is not well known and requires further studies.