Life-threatening ventricular arrhythmia due to silent coronary artery spasm: usefulness of I-123 metaiodobenzylguanidine scintigraphy for detecting coronary artery spasm in the era of automated external defibrillators: a case report

INTRODUCTION: Cardiac arrhythmia is sometimes life-threatening, and automated external defibrillators are presently used in some countries. Coronary artery spasm is one of the primary causes of life-threatening arrhythmia. In general, chest symptoms are key indicators of possible coronary artery spasm; however, if chest symptoms are not present, clinicians may not suspect this disease. We encountered a patient who had recovered from ventricular fibrillation treated by using an automated external defibrillator, and silent coronary artery spasm was considered to be the cause of this life-threatening arrhythmia. In this case, I-123 metaiodobenzylguanidine scintigraphy was a useful screening tool for a silent coronary artery spasm. CASE PRESENTATION: A 72-year-old Japanese man was transferred to our hospital after recovering from ventricular fibrillation treated by using an automated external defibrillator. He had never complained of chest symptoms previously. Decreased uptake of I-123 metaiodobenzylguanidine was observed in the inferolateral and anteroseptal walls of the left ventricle. A spasm provocation test of the coronary artery was performed, and silent coronary artery spasm was diagnosed as the underlying disease. CONCLUSION: Non-invasive I-123 metaiodobenzylguanidine scintigraphy was a useful screening tool for silent coronary artery spasm as a possible cause of cardiopulmonary arrest in a patient with no chest symptoms.