{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T15:24:43Z","timestamp":1792250683647,"version":"4.4.0"},"reference-count":12,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Physiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Coronary artery spasm (CAS), also known as vasospastic angina, is a functional coronary disorder that can precipitate transient myocardial ischemia and life-threatening ventricular arrhythmias. Although generally reversible, severe or multivessel CAS may lead to sudden cardiac death, and its optimal management remains controversial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We report a case of a 71-year-old man of Chinese ethnicity with a history of atrial fibrillation ablation and chronic obstructive pulmonary disease who presented with recurrent episodes of chest discomfort followed by sudden cardiac arrest. The patient experienced multiple episodes of ventricular tachycardia and ventricular fibrillation requiring repeated defibrillation and advanced cardiopulmonary resuscitation. Initial coronary angiography showed no significant fixed coronary stenosis. However, during recurrent ischemic episodes accompanied by dynamic ST-segment elevation, emergent repeat angiography demonstrated severe multivessel coronary spasm, including near-total occlusion of the mid left anterior descending artery and complete occlusion of the distal right coronary artery. Intracoronary nitrate administration promptly relieved the spasm and restored coronary flow. Despite intensive medical therapy with calcium channel blockers and nitrates and withdrawal of potential triggering agents, the patient suffered recurrent malignant ventricular arrhythmias. He ultimately underwent implantable cardioverter-defibrillator (ICD) implantation for secondary prevention. No ICD therapies were recorded during follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights that multivessel coronary artery spasm can provoke recurrent malignant ventricular arrhythmias even in the absence of fixed coronary stenosis. In patients with CAS complicated by recurrent ventricular fibrillation despite optimal medical therapy, ICD implantation may be a reasonable strategy for secondary prevention of sudden cardiac death.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphys.2026.1808973","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T04:40:38Z","timestamp":1781239238000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Recurrent ventricular fibrillation induced by multivessel coronary artery spasm: a case supporting ICD for secondary prevention"],"prefix":"10.3389","volume":"17","author":[{"given":"Ling","family":"Li","sequence":"first","affiliation":[{"name":"Laboratory Department, Tanzhou People\u2019s Hospital of Zhongshan, Zhongshan City Hospital of Integration of TCM & Western Medicine","place":["Zhongshan, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ningyuan County People\u2019s Hospital","place":["Yongzhou, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Baiyun Branch of the Third Affiliated Hospital of Guangzhou Medical University (Baiyun Maternal and Child Health Hospital","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1093\/europace\/euq481","article-title":"Implantable cardioverter defibrillator for sudden cardiac death secondary to coronary artery spasm","volume":"65","author":"Cheng","year":"1998","journal-title":"Int. J. Cardiol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1023\/a:1017955726199","article-title":"Arrhythmic sudden cardiac death due to coronary artery spasm","volume":"6","author":"Chevalier","year":"2002","journal-title":"Card. Electrophysiol. Rev."},{"key":"B3","doi-asserted-by":"publisher","first-page":"3738","DOI":"10.1093\/eurheartj\/ehaf284","article-title":"Refractory angina: Mechanisms and stratified treatment in obstructive and non-obstructive chronic myocardial ischaemic syndromes","volume":"46","author":"de Silva","year":"2025","journal-title":"Eur. Heart J."},{"key":"B4","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1016\/j.jjcc.2023.06.009","article-title":"JCS\/CVIT\/JCC 2023 guideline focused update on diagnosis and treatment of vasospastic angina (Coronary spastic angina) and coronary microvascular dysfunction","volume":"87","author":"Hokimoto","year":"2023","journal-title":"Circ. 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Heart J."},{"key":"B9","doi-asserted-by":"publisher","first-page":"2135","DOI":"10.1016\/j.jacc.2024.11.009","article-title":"2025 ACC\/AHA\/ACEP\/NAEMSP\/SCAI Guideline for the management of patients with acute coronary syndromes: A report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"85","author":"Rao","year":"2025","journal-title":"J. Am. Coll. Cardiol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1016\/j.hlc.2011.07.007","article-title":"Multivessel coronary artery spasm","volume":"21","author":"Richardson","year":"2012","journal-title":"Heart Lung Circ."},{"key":"B11","doi-asserted-by":"publisher","first-page":"453.e5","DOI":"10.1016\/j.ajem.2012.07.007","article-title":"Ventricular fibrillation caused by coronary artery spasm during mild therapeutic hypothermia after resuscitation","volume":"31","author":"Yamashina","year":"2013","journal-title":"Am. J. Emerg. Med."},{"key":"B12","doi-asserted-by":"publisher","first-page":"3997","DOI":"10.1093\/eurheartj\/ehac699","article-title":"2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death","volume":"43","author":"Zeppenfeld","year":"2022","journal-title":"Eur. Heart J."}],"container-title":["Frontiers in Physiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2026.1808973\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T04:41:03Z","timestamp":1781239263000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2026.1808973\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,12]]},"references-count":12,"alternative-id":["10.3389\/fphys.2026.1808973"],"URL":"https:\/\/doi.org\/10.3389\/fphys.2026.1808973","relation":{},"ISSN":["1664-042X"],"issn-type":[{"value":"1664-042X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,12]]},"article-number":"1808973"}}