Key result
A patient presenting with sudden cardiac death and a high-risk 'shark fin' ECG pattern due to right coronary artery spasm was treated with primary stenting and an intracardiac defibrillator.
Why the study?
Data reporting the association between coronary vasospasm-induced sudden cardiac death and specific high-risk ECG patterns, such as the QRS-ST-T shark fin pattern, are scant.
Case Report (n=1)
The presence of a 'shark fin' ECG pattern during coronary vasospasm may indicate a high risk for sudden cardiac death, suggesting a potentially lower threshold for ICD implantation in these patients.
May warrant ICD consideration in shark fin ECG with vasospasm; hypothesis-generating case report leaves threshold changes open.
Malignant ventricular arrhythmic storm and sudden cardiac death (SCD) following coronary vasospasm (CVS) are relatively uncommon. On another note, a specific pattern, the QRS-ST-T “shark fin” pattern on ECG, is known to be a high-risk pattern and is associated with a very poor prognosis in the context of coronary artery occlusion. Data reporting the association of CVS-induced SCD and specific high-risk ECG patterns is scant. Herein we present a case of a patient with right coronary artery (RCA) spasm who presented in sudden cardiac death and a “shark fin” pattern on ECG. Primary stenting of the residual lesion after intra-coronary nitroglycerin was performed. The patient received optimal medical therapy and an intracardiac defibrillator. Lowering the threshold for defibrillator implantation may be reasonable in CVS-induced ventricular arrhythmias particularly in the presence during vasospasm of high-risk ECG features such as the “shark fin” pattern.
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Kechichian et al. (2020) conducted a case report in Right coronary artery spasm and sudden cardiac death (n=1). Right coronary artery spasm with 'shark fin' ECG pattern was evaluated. A patient presenting with sudden cardiac death and a high-risk 'shark fin' ECG pattern due to right coronary artery spasm was treated with primary stenting and an intracardiac defibrillator.
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