Key result
Provocation testing identifies severe multivessel coronary spasm driving recurrent PEA arrest refractory to ICD therapy.
Case Report (n=1)
No
Highlights coronary artery spasm as a rare but critical differential diagnosis for unexplained recurrent pulseless electrical activity cardiac arrest that can be diagnosed with provocation testing.
May warrant provocation testing in unexplained recurrent PEA arrest despite ICD; case report leaves open broader diagnostic adoption.
Key Teaching Points•It is important to consider coronary artery spasm (CAS) in the differential diagnosis when there is an absence of other obvious causes of cardiac arrest.•Provocation testing can help diagnose CAS, given that spontaneous CAS may not be detected during routine coronary evaluation.•Medical treatment for CAS with calcium channel blockers and/or nitrates is the cornerstone of care.•Implantable cardioverter-defibrillator implantation has been shown to reduce mortality from CAS-related ventricular tachyarrhythmia arrest but not pulseless electrical activity. •It is important to consider coronary artery spasm (CAS) in the differential diagnosis when there is an absence of other obvious causes of cardiac arrest.•Provocation testing can help diagnose CAS, given that spontaneous CAS may not be detected during routine coronary evaluation.•Medical treatment for CAS with calcium channel blockers and/or nitrates is the cornerstone of care.•Implantable cardioverter-defibrillator implantation has been shown to reduce mortality from CAS-related ventricular tachyarrhythmia arrest but not pulseless electrical activity.
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Xi et al. (2023) conducted a case report in Recurrent out-of-hospital cardiac arrest (pulseless electrical activity) (n=1). Coronary provocation testing and calcium channel blockers was evaluated. Severe triple-vessel coronary artery spasm was identified via provocation testing as the underlying cause of recurrent pulseless electrical activity cardiac arrest, which is not prevented by an implantable cardioverter-defibrillator.
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