Key result
Subcutaneous implantable cardioverter-defibrillator combined with calcium channel blockers prevented sudden cardiac death with no recurrent ventricular arrhythmias or appropriate shocks during 1 year of follow-up.
Why the study?
Does subcutaneous implantable cardioverter-defibrillator implantation prevent sudden cardiac death in a patient with ventricular fibrillation caused by coronary artery spasm?
Case Report (n=1)
No
Does subcutaneous implantable cardioverter-defibrillator implantation prevent sudden cardiac death in a patient with ventricular fibrillation caused by coronary artery spasm?
Subcutaneous ICDs are a viable, less-invasive option for secondary prevention of sudden cardiac death in coronary artery spasm patients who lack structural heart disease and do not require bradycardia pacing.
Answers are grounded in this paper and cite their sources.
Subcutaneous ICD plus calcium channel blockers may prevent recurrent VF in coronary spasm; extends sparse case evidence but leaves open need for prospective trials.
BACKGROUND: Coronary artery spasm usually has a good prognosis, except when it induces lethal ventricular arrhythmias. Implantable cardioverter-defibrillator (ICD) implantation in addition to optimal medical therapy including prescription of coronary vasodilators and smoking cessation is a therapeutic option for coronary artery spasm patients who present with lethal ventricular arrhythmia. Subcutaneous ICDs are now available as an alternative to conventional transvenous ICDs. CASE SUMMARY: We report the first case of a 50-year-old Japanese male without any structural heart disease who presented with ventricular fibrillation caused by coronary artery spasm, and underwent subcutaneous ICD implantation for secondary prevention of sudden cardiac death (SCD). We attributed his aborted SCD to coronary artery spasm based on findings of cardiac catheterization including acetylcholine provocation test and cardiac electrophysiological study. During the 1 year of follow-up, the patient discharged on calcium channel blockers and nicorandil has been free of angina, ventricular arrhythmias, and appropriate ICD therapy. DISCUSSION: Coronary artery spasm patients with aborted SCD may be good candidates for implantation of subcutaneous ICDs, because most of them have no need for concomitant bradycardia therapy, cardiac resynchronization therapy, or anti-tachycardia pacing therapy.
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Ito et al. (2018) conducted a case report in Ventricular fibrillation caused by coronary artery spasm (n=1). Subcutaneous implantable cardioverter-defibrillator (S-ICD) was evaluated on Freedom from angina, ventricular arrhythmias, and appropriate ICD therapy. Subcutaneous implantable cardioverter-defibrillator combined with calcium channel blockers prevented sudden cardiac death with no recurrent ventricular arrhythmias or appropriate shocks during 1 year of follow-up.
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