Recurrent ventricular fibrillation under sufficient medical treatment in patient with coronary artery spasm

In cases of coronary artery spasm, life-threatening ventricular arrhythmias are possible and can lead to sudden cardiac death. Treatment for this condition includes implantable cardioverter defibrillators, but their effectiveness in patients who present with ventricular fibrillation is debated. Our patient presented with intractable ventricular fibrillation episodes that triggered shocks from her implanted defibrillator. At 2 years of follow-up, we placed her on 200 mg/day of oral amiodarone, after identifying short-coupled premature contractions as the trigger for the ventricular fibrillation. In the 2 years following initiation of this drug therapy, the patient had no further fibrillation episodes.