Work

Ventricular Fibrillation From Spontaneous Coronary Artery Dissection in a Patient With Atrioventricular Nodal Re-entrant Tachycardia: Rationale for Implantable Cardioverter Defibrillator Therapy

Year: 2025

Type: article

Abstract: Ventricular fibrillation (VF) management requires identification of the underlying cause and consideration of implantable cardioverter defibrillator (ICD) therapy; these decisions are complicated when the aetiology is unclear. We present a 41-year-old woman with lifelong atrioventricular nodal re-entrant tachycardia (AVNRT) who experienced cardiac arrest secondary to VF. Multimodality cardiac imaging identified features suggestive of spontaneous coronary artery dissection (SCAD) with transient vessel healing but a new apical scar. Given the scar-related arrhythmogenic substrate, risk of SCAD recurrence, and prior AVNRT episodes degenerating into polymorphic ventricular tachycardia (PMVT), a single-chamber ICD was implanted. This case highlights the need to avoid diagnostic anchoring on the pre-existing arrhythmia as the cause for cardiac arrest and demonstrates the value of imaging in identifying SCAD as the cause and in guiding ICD decision-making.

Source: Cureus

DOI: 10.7759/cureus.98081

Authors: Rehan Akhtar, Jennifer Llewellyn, Matthew Grant

Institutions: Royal Brompton Hospital, Liverpool Heart and Chest Hospital, Countess of Chester Hospital

Language: English

Topic: Cardiac Arrhythmias and Treatments

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W4416817167