Exercise-induced ventricular arrhythmia due to bilateral coronary to pulmonary artery fistulas

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Coronary artery fistulas (CPAFs) are rare congenital or acquired abnormalities.
• Myocardial ischemia can result from significant shunting of blood through CPAFs, causing a 'steal phenomenon'.
• Ventricular ectopy, particularly polymorphic ventricular tachycardia, can be a manifestation of myocardial ischemia.

Observation:

• A 65-year-old male presented with ischemic polymorphic ventricular ectopy during exercise testing.
• Coronary angiography identified four coronary to pulmonary artery fistulas originating from both the right and left coronary arteries.
• The fistulas led to myocardial ischemia attributed to a significant coronary steal phenomenon.

Findings:

• Three dominant CPAFs were successfully treated with percutaneous coiling.
• One small, non-dominant fistula was intentionally left untreated.
• Post-treatment follow-up revealed no significant residual ventricular arrhythmia.

Implications:

• Percutaneous coiling is an effective treatment for hemodynamically significant coronary artery fistulas causing myocardial ischemia and ventricular arrhythmias.
• Management of CPAFs should be tailored to fistula size and hemodynamic impact.
• Successful intervention can resolve serious cardiac manifestations like ventricular ectopy, improving patient outcomes.