Conclusion:
Life threatening arrhythmias is one of the complications of SCAD. Conservative management is recommended for most patients with SCAD and revascularization is typically reserved for high risk patients with life threatening arrhythmias and ongoing ischemia. While consensus exists on revascularization in patients with life threatening arrhythmias, timing and criteria for device therapy for secondary prophylaxis for SCD in the setting of SCAD is unclear. This case highlights the propensity of some patients to have recurrences of SCAD as well as recurrences of life threatening arrhythmias, who would benefit from placement of an implantable cardioverter– defibrillator. Larger studies are needed to identify high risk patients and to define the role of early device therapy in patients with recurrent SCAD with or without life threatening arrhythmias.