Key result
Subcutaneous ICD leads to recurrent inappropriate shocks and untreated bradycardia during coronary spastic angina.
Why the study?
The effectiveness of subcutaneous implantable cardioverter-defibrillators in patients with coronary artery spastic angina and aborted sudden cardiac death remains controversial.
Is subcutaneous implantable cardioverter-defibrillator (S-ICD) appropriate for secondary prevention in a patient with coronary spastic angina?
Case Report (n=1)
No
Is subcutaneous implantable cardioverter-defibrillator (S-ICD) appropriate for secondary prevention in a patient with coronary spastic angina?
S-ICD may be inappropriate for patients with coronary spastic angina due to the unpredictable risk of ischemic severe bradycardia needing pacing and inappropriate shocks from transient low R-wave amplitude.
S-ICD may carry risks in coronary spastic angina; case report leaves open optimal device selection for secondary prevention.
BACKGROUND: Implantable cardioverter-defibrillator (ICD) is recommended for secondary prevention in patients with coronary spastic angina and aborted sudden cardiac death. The effectiveness of subcutaneous ICD (S-ICD) for patients with coronary artery spastic angina is controversial. CASE SUMMARY: A 54-year-old man presented with ventricular fibrillation. Emergent coronary angiography showed diffuse narrowing of the coronary arteries that was reversible with isosorbide dinitrate. He was diagnosed with coronary spastic angina. S-ICD was implanted after the administration of a calcium-channel blocker and nicorandil. Seven months after the implantation, he collapsed again due to sinus node dysfunction and atrioventricular block caused by cardiac ischaemia. He developed cardiac arrest at both admissions. Six hours after the admission, electrocardiogram showed transient right bundle branch block. Inappropriate shocks were delivered because of low R-wave amplitude and T-wave oversense. S-ICD was replaced with a transvenous device in order to manage these two arrhythmias and inappropriate shocks. DISCUSSION: Patients with coronary artery spasm and aborted sudden cardiac death are candidates for implantation of S-ICD, but there are risks of bradycardia and inappropriate shocks in other ischaemic events.
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Kojima et al. (2020) conducted a case report in Coronary spastic angina and aborted sudden cardiac death (n=1). Subcutaneous implantable cardioverter-defibrillator (S-ICD) was evaluated on Occurrence of inappropriate shocks and severe bradycardia during subsequent ischemic events. Subcutaneous ICD in a patient with coronary spastic angina led to 21 inappropriate shocks due to transient ECG alterations and failed to treat severe ischemic bradycardia, requiring transvenous ICD replacement.
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