Subcutaneous implantable cardioverter-defibrillator was inappropriate for use in a patient with aborted sudden cardiac death due to coronary spastic angina: a case report

Abstract

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.

Recurrent cardiac arrest and complete atrioventricular block due to idiopathic coronary vasospasm: A case report

“…The treatment of coronary spasm with CAVB involves medical therapy, temporary pacemaker, and ICD [ 2 , 3 , [6] , [7] , [8] ]. Medical therapy mainly includes calcium channel blockers (CCB) and nitrates, which can prevent and relieve coronary spasm and reduce the risk of CAVB [ 6 ].…”

“…Recently, several cases of coronary spasm leading to hemodynamic compromise and recurrent syncope, bradycardia (e.g., ventricular standstill, complete atrioventricular block, etc.) following brief cardiopulmonary resuscitation have been described in the literature [ 2 , 3 , 9 ]. These cases showed no obstructive coronary artery disease on angiography and had a favorable outcome after ICD implantation and 1–2 months of follow-up without further episodes.…”

“…Coronary spasm can cause transient ischemia of the sinoatrial node, atrioventricular node, or His-Purkinje system, resulting in various types of bradyarrhythmias(2). However, recurrent CAVB induced by coronary spasm is extremely uncommon and only a few cases have been reported in the literature [ 2 , 3 ].…”

Case report: Implantable cardioverter-defibrillator implantation with optimal medical treatment for lethal ventricular arrhythmia caused by recurrent coronary artery spasm due to tyrosine kinase inhibitors

“…Optimal medical therapy (OMT), including long-acting calcium channel blockers and nitrate, is the baseline treatment for the prevention of CAS recurrence. Nevertheless, an implantable cardioverter-defibrillator (ICD) is recommended for those who have experienced aborted SCD in addition to OMT ( 4 , 5 ). In this study, we report a case of a patient who had multiple precipitated risk factors for CAS further managed with OMT and simultaneous ICD implantation for secondary prevention of SCD.…”