Spontaneous termination of ventricular fibrillation in a patient with congenital coronary anomaly
Oscar A Pellizzón1, Lorena Scaglione, Ana E Chiesa
1Arrhythmia Center, Centenario Hospital, National University of Rosario, Rosario, Argentina.
Insights
Sudden cardiac arrest from coronary artery anomalies can be fatal. This case report details the first instance of spontaneous ventricular fibrillation termination in a patient with anomalous coronary arteries.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Anatomical Variations
Background:
- Congenital coronary artery anomalies, particularly origin from the right coronary sinus, are a significant cause of sudden cardiac death.
- Ventricular fibrillation in these patients typically requires immediate defibrillation for survival.
Observation:
- A 57-year-old male presented with anomalous origin of the circumflex and left anterior descending coronary arteries from the right coronary sinus.
- He experienced two episodes of ventricular fibrillation that resolved spontaneously post-percutaneous revascularization of the circumflex artery.
- Computed tomography angiography confirmed the anomalous coronary origin and identified a muscle bridge over the left anterior descending artery.
Findings:
- This case represents the first documented occurrence of spontaneous termination of ventricular fibrillation in a patient with congenital coronary artery anomalies.
- The spontaneous resolution of ventricular fibrillation suggests potential protective mechanisms or altered electrophysiological substrate in this specific anomaly.
Implications:
- Understanding spontaneous termination mechanisms may offer new therapeutic insights for managing ventricular fibrillation in coronary anomalies.
- This case highlights the importance of comprehensive imaging and anatomical assessment in patients with unexplained ventricular fibrillation.
- Further research into the electrophysiological characteristics of anomalous coronary arteries is warranted.
Abstract:
Sudden death is common in patients with congenital coronary artery anomalies mainly when the left main coronary artery originates from the right coronary sinus. Ventricular fibrillation in these patients is irreversible unless defibrillation can be rapidly performed. We describe a 57-year-old male with an anomalous origin of circumflex and the left anterior descending coronary arteries from the right coronary sinus. He developed two episodes of ventricular fibrillation that terminated spontaneously, 10 hours after percutaneous revascularization of the circumflex coronary artery. Computed tomography angiography, in addition to confirming the anomalous origin of the coronary arteries, showed a muscle bridge over the midportion of the left anterior descending coronary artery. This is the first report of spontaneous termination of ventricular fibrillation in a patient with congenital anomaly of the coronary arteries.
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