Coronary vasospasm-induced periodic ventricular fibrillation and successful ablation through coronary stenting

Introduction

Coronary vasospasm-induced ventricular fibrillation (VF) is a well-documented clinical condition, and there are existing reports in medical publications on this subject [1]. Treatment approaches for these patients can be challenging. In most cases, vasodilator therapy relieves anginal and VF episodes, but sometimes, in the case of recurrence, intracardiac defibrillator (ICD) implantation is performed with concomitant medical therapy [2]. When a patient receives multiple ICD shocks for recurrent VF episodes after vasospastic attacks in spite of the use of vasodilator therapy, it is an undesirable situation for both the patient and the doctor.
In this paper, we present a case of a patient suffering from this clinical condition that was successfully treated through coronary stent placement.

Case report

A 59-year old male patient was referred to our hospital after suffering a VF attack and was successfully treated with defibrillation. At his initial evaluation, the patient’s mind was clear and his hemodynamic parameters and other physical examination findings were normal. His electrocardiogram results indicated a sinus rhythm with a rate of 60 bpm, there was no significant ischemic finding, the QT interval was normal and there was no suggestion of Brugada syndrome or arrhythmogenic right ventricular dysplasia (Figure 1 A). Biochemical tests including cardiac troponin, serum potassium and magnesium levels were all normal. His previous medical history indicated that there had been two syncopal episodes within the last 2 months. There were no specific triggers for these episodes, but the patient described anginal chest pain immediately before the syncopal attacks. He had experienced no exercise-induced angina, and there were no instances in his family history of sudden death of unknown origin. His echocardiogram results showed that the cardiac chambers were of a normal size, there was normal systolic function of both left and right ventricles, and the wall thickness was also normal. Coronary angiography was administered and a moderate lesion was detected in the middle portion of the right coronary artery (RCA) (Figures 2 A–C). This lesion was evaluated with fractional flow reserve (FFR) using 200 µg and then 300 µg intravenous adenosine injections. The FFR ratio was found to be 0.86. Amiodarone perfusion was administered at the time of his first medical contact, and this treatment was continued for 24 h. The day after...


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