Ventricular fibrillation survivor due to painless multiple spasm including left main trunk: is the subcutaneous implantable cardioverter-defibrillator necessary?

A 52-year-old man was transferred to our hospital for ventricular fibrillation. He had no chest symptoms until then. After his full recovery, the administration of acetylcholine 20 μg showed the multiple spasm (left main trunk/left anterior descending artery/right coronary artery) without any chest symptoms or ischemic electrocardiographic changes. Subcutaneous implantable cardioverter-defibrillator (S-ICD) was implanted because of no chest symptoms during his-daily-life. We performed the pharmacological spasm provocation tests under the abundant medications. Sequential spasm provocation test provoked just focal spasm at mid left anterior descending artery. We convinced that medications and S-ICD suppress the next fatal event. <Learning objective: LMT spasm may cause aborted SCD. Aggressive spasm provocation tests under the abundant medical therapy provoked spasm just at mid LAD artery focally in patient with VF survivor due to multiple spasm including LMT, while these medications blocked the LMT and RCA spasm. S-ICD implantation may be one of the selections in aborted SCD patients with silent LMT spasm under the abundant vasodilators in the future.>.