Peer-review started: June 16, 2016
First decision: July 11, 2016
Revised: September 12, 2016
Accepted: November 16, 2016
Article in press: November 17, 2016
Published online: January 26, 2017
Processing time: 221 Days and 12.4 Hours
A 56-year-old man experienced an aborted sudden death followed by an arrhythmic storm. Angiography revealed a non-severe lesion on the left circumflex artery that was treated medically but an arrhythmic storm recurred. A repeat angiogram was comparable but optical coherence tomography imaging revealed a ruptured plaque with intraluminal thrombosis. Percutaneous coronary intervention was performed and no arrhythmia recurred.
Core tip: A 56-year-old man presented to a community hospital after an aborted sudden death. After initial resuscitation, he presented an arrhythmic storm with multiple episodes of ventricular fibrillation refractory to intravenous amiodarone. Coronary angiogram showed a nonobstructive intermediate lesion in the mid left circumflex artery. Because of repeated ventricular fibrillation episodes, an optical coherence tomography (OCT) was performed and revealed a ruptured thin-cap fibroatheroma with an intraluminal thrombosis at the level of the intermediate lesion. This case suggests that performing OCT to detect vulnerable culprit lesion of less than severe angiographic severity when an ischemic event is likely, such as an aborted sudden death or arrhythmic storm, may be of diagnostic value and alter therapeutic decisions.