We report a case of a 62-year-old Japanese man with ventricular fibrillation(VF) refractory to direct-current(DC) shocks accompanied by vasospastic angina pectoris(VSA). The patient was referred to our institute for radiofrequency catheter ablation of atrial fibrillation(AF) and developed coronary artery spasms in the distal right coronary artery(RCA) and distal left circumflex coronary artery immediately after performing the AF ablation, which were relieved via an intracoronary administration of isosorbide dinitrate. Thereafter, an oral calcium antagonist was effective in preventing the VSA. However, VF occurred after an inguinal hernia repair under general anesthesia and could not be terminated by repeated DC shocks. A percutaneous cardiopulmonary support(PCPS) system was instituted immediately under cardiopulmonary resuscitation. Emergency coronary angiography revealed a total occlusion of the ostial RCA. The persistent VF was at last successfully terminated with a DC shock which was performed after the occlusion of the RCA was relieved by the intracoronary administration of isosorbide dinitrate. The patient received an implantable cardioverter-defibrillator, oral nitrates and calcium antagonists. Coronary vasodilators might play an important role in the termination of VF refractory to repeated DC shocks in patients with VSA episodes.

View full abstract