Refractory Vasospastic Angina and Sudden Cardiac Arrest: Is Implantable Cardioverter Defibrillator Indicated and Is It Always Protective?

Abstract

Vasospastic angina (VSA) is characterized by episodic chest pain associated with transient STsegment abnormalities on electrocardiogram, secondary to vasospasm of the epicardial coronary artery. We report the rare case of a 46-year-old female with refractory VSA secondary to multivessel coronary vasospasm causing an anterior myocardial infarction. She succumbed secondary to ventricular tachycardia (VT) storm, in spite of being on maximally tolerated medical therapy and having an implantable cardioverter defibrillator (ICD) for secondary prevention of VT. Contemporary guidelines recommend ICD implantation (class IIa) in VSA patients who survived sudden cardiac arrest (SCA), if they are already on optimal medical therapy or if medical therapy is not tolerated. Whether ICD implantation is appropriate in VSA patients with aborted SCA, even before assessing the response to medical therapy, is not well known and requires further studies.

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

“…However, there are no guidelines for ICD implantation in primary prevention for coronary vasospasm despite its potential to cause lethal arrhythmias. In secondary prevention, contemporary guidelines recommend ICD implantation in these patients, if they are already on optimal medical therapy or if medical therapy is not tolerated (Class IIa) [ 12 ]. The indication for ICD should be restricted to life-threatening situations, which are defined by the following criteria: i) ventricular fibrillation or sustained ventricular tachycardia; ii) syncope or cardiac arrest; iii) high-degree atrioventricular block or sinoatrial block; iv) left ventricular ejection fraction less than 35 %; v) familial history of sudden cardiac death or inherited arrhythmia syndrome [ 10 ].…”