Myocardial Bridging and Cardiac Arrest

BACKGROUND: Myocardial bridging (MB) is a congenital coronary anomaly in which a segment of an epicardial artery tunnels through the myocardium. Although frequently considered benign, MB has been increasingly linked to ischemia, malignant arrhythmias, and sudden cardiac death. CASE SUMMARY: We describe a case of a 39-year-old woman with mid-left anterior descending artery MB who presented with sudden chest pain followed by cardiac arrest. Coronary angiography revealed MB without obstructive disease. Despite prolonged resuscitation and hypoxic brain injury, she achieved functional recovery after intensive care. DISCUSSION: We compared our patient with 10 previously published cases of MB-associated cardiac arrest. Patients were typically men with ventricular fibrillation as the universal arrest rhythm, and the left anterior descending artery was most commonly involved, with variable outcomes. TAKE-HOME MESSAGES: MB should not be regarded as uniformly benign. Recognition of its malignant potential-particularly in patients with no obstructive coronary disease-is critical for diagnosis, management, and secondary prevention.