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Coronary vasospasm and aborted sudden death treated with an implantable defibrillator and stenting
Luigi Fiocca1, Maurizio Di Biasi, Nicola Bruno
1Department of Cardiology, Multimedica Hospital, Sesto San Giovanni, MI, Italy. luigifiocca@yahoo.com
Insights
Implantable cardioverter-defibrillators (ICDs) and coronary stenting can prevent sudden death in variant angina patients. This case shows successful treatment of coronary artery spasm and ventricular fibrillation with ICD and stenting.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Variant angina (Prinzmetal's angina) is characterized by coronary artery spasm.
- Sudden cardiac death can occur due to ventricular arrhythmias in variant angina.
Observation:
- A 47-year-old woman with variant angina experienced ventricular fibrillation.
- Initial treatment included an implantable cardioverter-defibrillator (ICD) and medical management.
- Recurrent symptoms led to repeat angiography revealing focal coronary artery spasm.
Findings:
- Coronary artery stenting successfully treated the focal coronary artery spasm.
- The patient remained free of angina and ventricular arrhythmias for 6 months post-procedure.
Implications:
- Combined ICD implantation and coronary stenting offer a viable treatment strategy for selected variant angina patients.
- This approach can effectively manage both life-threatening arrhythmias and underlying coronary vasospasm.
- Highlights the importance of reassessment for coronary spasm in refractory angina with arrhythmias.
Abstract:
In selected patients suffering from variant angina, an implantable cardioverter-defibrillator (ICD) and coronary stenting can be helpful to prevent sudden death and treat coronary artery spasm. We report a case of a 47-year-old woman suffering from variant angina, who experienced an episode of ventricular fibrillation promptly cardioverted. After coronary angiography documentation of a mild atherosclerosis, an ICD was implanted and oral nitrates and calcium antagonists were prescribed. The recurrence of chest pain and palpitations prompted us to perform a second coronary angiography that documented a focal coronary artery spasm successfully treated with stent implantation. No other episodes of angina or ventricular arrhythmia were documented during the following 6 months of follow-up.