Kojima Akiteru, Shirayama Takeshi, Shiraishi Jun, Sawada Takahisa
Department of Cardiovascular Medicine, Japanese Red Cross Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama-Ku, Kyoto 605-0981, Japan.
Department of Cardiology, Omihachiman Community Medical Center, 1379 Tsuchidacho, Omihachiman, Shiga 523-0082, Japan.
Eur Heart J Case Rep. 2020 Dec 12;4(6):1-5. doi: 10.1093/ehjcr/ytaa471. eCollection 2020 Dec.
Implantable cardioverter-defibrillator (ICD) is recommended for secondary prevention in patients with coronary spastic angina and aborted sudden cardiac death. The effectiveness of subcutaneous ICD (S-ICD) for patients with coronary artery spastic angina is controversial.
A 54-year-old man presented with ventricular fibrillation. Emergent coronary angiography showed diffuse narrowing of the coronary arteries that was reversible with isosorbide dinitrate. He was diagnosed with coronary spastic angina. S-ICD was implanted after the administration of a calcium-channel blocker and nicorandil. Seven months after the implantation, he collapsed again due to sinus node dysfunction and atrioventricular block caused by cardiac ischaemia. He developed cardiac arrest at both admissions. Six hours after the admission, electrocardiogram showed transient right bundle branch block. Inappropriate shocks were delivered because of low R-wave amplitude and T-wave oversense. S-ICD was replaced with a transvenous device in order to manage these two arrhythmias and inappropriate shocks.
Patients with coronary artery spasm and aborted sudden cardiac death are candidates for implantation of S-ICD, but there are risks of bradycardia and inappropriate shocks in other ischaemic events.
对于冠状动脉痉挛性心绞痛和心脏性猝死复苏后的患者，推荐植入式心律转复除颤器（ICD）用于二级预防。皮下植入式心律转复除颤器（S-ICD）用于冠状动脉痉挛性心绞痛患者的有效性存在争议。
一名54岁男性出现心室颤动。急诊冠状动脉造影显示冠状动脉弥漫性狭窄，使用硝酸异山梨酯后可逆转。他被诊断为冠状动脉痉挛性心绞痛。在给予钙通道阻滞剂和尼可地尔后植入了S-ICD。植入后7个月，他因心脏缺血导致的窦房结功能障碍和房室传导阻滞再次晕倒。他两次入院时均发生心脏骤停。入院6小时后，心电图显示短暂性右束支传导阻滞。由于R波振幅低和T波感知过度，出现了不适当电击。为了处理这两种心律失常和不适当电击，将S-ICD换成了经静脉装置。
冠状动脉痉挛和心脏性猝死复苏后的患者是植入S-ICD的候选者，但在其他缺血事件中存在心动过缓和不适当电击的风险。
