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.