Key result
Coronary reimplantation with S-ICD improves LVEF and prevents recurrent arrhythmias in adult ALCAPA arrest.
Why the study?
Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart condition with high childhood mortality if untreated, making diagnosis in asymptomatic adults and initial presentation with sudden cardiac arrest exceedingly uncommon.
Case Report (n=1)
No
This case report highlights that sudden cardiac arrest can be the initial manifestation of ALCAPA in asymptomatic young adults and demonstrates the role of multimodality imaging in guiding surgical correction and secondary prevention S-ICD implantation.
Adult ALCAPA arrest may warrant surgical repair plus S-ICD; leaves open prospective validation of long-term arrhythmia-free survival.
Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart condition associated with high childhood mortality if untreated.Consequently, diagnosis in asymptomatic adults is exceedingly uncommon.We report a 21-year-old gentleman brought to hospital via the primary percutaneous coronary intervention service after an out-of-hospital ventricular fibrillation arrest while hiking.Following prehospital cardiopulmonary resuscitation and defibrillation, return of spontaneous circulation was achieved; an immediate 12-lead electrocardiogram showed ST elevation.Initial transthoracic echocardiography revealed abnormal myocardial color Doppler flow, suggesting intercoronary collaterals and raising suspicion of a coronary anomaly.Coronary angiography confirmed ALCAPA.He underwent successful reimplantation surgery.Given myocardial fibrosis on cardiac magnetic resonance imaging, a subcutaneous implantable cardioverter-defibrillator was implanted for secondary prevention.Sudden cardiac arrest as the initial presenting symptom is exceedingly rare in an asymptomatic young adult with ALCAPA.High clinical suspicion supports early diagnosis.Multi-modality imaging remains central to diagnosis and device-therapy decisions after corrective surgery.
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Shrestha et al. (2026) conducted a case report in Anomalous left coronary artery originating from the pulmonary artery (ALCAPA) presenting with sudden cardiac arrest (n=1). Coronary reimplantation surgery and subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation was evaluated on Postoperative left ventricular ejection fraction and freedom from arrhythmias. Coronary reimplantation surgery and S-ICD implantation improved LVEF from 45% to 50-55% with no recurrent arrhythmias over 6 months in a 21-year-old male presenting with cardiac arrest from ALCAPA.
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