Subcutaneous implantable cardioverter defibrillator for spontaneous coronary artery dissection with ventricular fibrillation: A report of two cases

Implantable Cardioverter-Defibrillator Placement in Spontaneous Coronary Artery Dissection: A Case Report

“…Some patients with SCAD possess certain features that increase the risk of SCD, such as STEMI on presentation, a history of VF, and SCAD recurrence [ 2 , 5 ] ( Table 1 ). Complications from SCAD are not uncommon, with a 47% rate of major adverse cardiovascular events and about 30% rate of SCAD recurrence within 10 years.…”

“…Ueda et al discussed 2 cases in which the patients presented with acute VF and were found to have SCAD on further imaging studies. A subcutaneous ICD was implanted in both patients [ 5 ].…”

“…There is a Japanese retrospective study that showed a 2% incidence of SCD and 36% incidence of non-fatal MI during a median follow-up of 50 months after SCAD onset. For the patients who had non-fatal MI, 25% had potential progression of primary SCAD, and 75% had recurrent SCAD [ 5 , 6 ]. The authors of the PACIFIC registry studied Japanese patients with acute coronary syndrome.…”

“…They discovered that in patients who presented with STEMI, there is a 4.2% recurrence rate of non-fatal MI and/or unstable angina at 2 years. Since SCAD has a high recurrence rate, it can be postulated that the recurrence rate of non-fatal MI and/or unstable angina after STEMI would be higher in patients with SCAD [ 5 , 7 ]. The Japanese Circulation Guidelines have a class 2b recommendation to implant an ICD in a patient who has VT/VF within 48 h of an MI that is due to a cause that has a high risk of re-exposure [ 5 ].…”

“…Since SCAD has a high recurrence rate, it can be postulated that the recurrence rate of non-fatal MI and/or unstable angina after STEMI would be higher in patients with SCAD [ 5 , 7 ]. The Japanese Circulation Guidelines have a class 2b recommendation to implant an ICD in a patient who has VT/VF within 48 h of an MI that is due to a cause that has a high risk of re-exposure [ 5 ]. Thus, it can be reasoned that the Japanese Circulation Guidelines would recommend ICD implantation in a patient with VT/VF due to SCAD, since SCAD has a high recurrence rate, making the patient susceptible to SCD.…”