Subcutaneous implantable cardioverter defibrillator for spontaneous coronary artery dissection with ventricular fibrillation: A report of two cases

Abstract

The efficacy of implantable cardioverter defibrillators (ICDs) for secondary prevention in spontaneous coronary artery dissection (SCAD) with ventricular fibrillation (VF) remains unclear. Herein, we report two cases of SCAD. In both cases, VF and ST-elevation myocardial infarction (STEMI) were noted, which were previously reported to increase the risk of VF recurrence and sudden cardiac death (SCD). Hence, a subcutaneous (S)-ICD was implanted for secondary prevention in each case. Previous studies have suggested that among patients with SCAD, those with a history of VF and left ventricular ejection fraction (LVEF) of <50% are at a higher risk of ventricular tachycardia or VF recurrence, whereas those with a history of smoking, STEMI, onset during pregnancy, recurrent SCAD, LVEF <50%, and left coronary artery main trunk lesion or proximal lesion are at a higher risk of SCD. Moreover, S-ICD is associated with fewer complications than transvenous-ICD, and the rate of inappropriate shock is decreasing. Therefore, risk stratification and consideration of S-ICD implantation in high-risk patients may be an important therapeutic strategy for the secondary prevention of SCAD.

Learning objective: Previous studies have not shown the efficacy of implantable cardioverter defibrillators (ICDs) for spontaneous coronary artery dissection (SCAD). Meanwhile, it was also suggested that patients with SCAD, including those with a history of ventricular fibrillation (VF) and ST-elevation myocardial infarction, are at high risk of VF recurrence or sudden cardiac death. For the secondary prevention of SCAD with VF, subcutaneous ICD implantation in high-risk patients may be an important strategy.

Keywords: Spontaneous coronary artery dissection; Subcutaneous implantable cardioverter defibrillator; Ventricular fibrillation.