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Coronary artery spasm as a cause of ST elevation and inappropriate implantable cardioverter defibrillator

Giosuè Mascioli1, Luca Bontempi, Marco Racheli

  • 1Department of Cardiology, Spedali Civili di Brescia, Italy. giosue.mascioli@virgilio.it

Journal of Cardiovascular Medicine (Hagerstown, Md.)
|December 29, 2007
PubMed

Insights

Coronary artery spasm can cause arrhythmias and trigger inappropriate implantable cardioverter defibrillator (ICD) firing due to ST segment elevation. This case highlights a unique ICD malfunction caused by coronary artery spasm.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Coronary artery spasm is a known cause of cardiac arrhythmias, including bradycardia and tachyarrhythmia.
  • Electrocardiographically, coronary artery spasm typically manifests as ST segment elevation.
  • Implantable cardioverter defibrillators (ICDs) are used to manage life-threatening ventricular arrhythmias.

Observation:

  • A patient with an ICD for unexplained syncope experienced coronary artery spasm.
  • During the spasm, the ICD delivered an inappropriate shock.
  • The inappropriate shock was attributed to ST segment elevation mimicking a ventricular arrhythmia.

Findings:

  • The ST segment elevation caused by coronary artery spasm led to double counting of the QRS complex by the ICD.
  • This QRS counting error resulted in the device misinterpreting the rhythm as a life-threatening arrhythmia.
  • Consequently, the ICD delivered an inappropriate shock.

Implications:

  • This case underscores the potential for coronary artery spasm to cause ICD malfunction.
  • Accurate interpretation of ECG changes during coronary artery spasm is crucial for appropriate ICD programming and function.
  • Further research may be needed to refine ICD algorithms to differentiate between true arrhythmias and artifact from coronary artery spasm.

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