Can Colakoglu, Yusuf Hopac
Eurasian Journal of Critical Care - 2025;7(3):47-50
Coronary artery fistulas are rare anomalies (incidence ~0.1-0.2% on angiography) characterized by an abnormal communication between a coronary artery and a cardiac chamber or vessel. Most small fistulas are asymptomatic, while larger fistulas can cause myocardial ischemia, heart failure, or even arrhythmias due to a coronary steal phenomenon. Notably, arrhythmias are an uncommon presentation - one review found that while 34% of patients had angina and 13% had heart failure, arrhythmias were rarely reported. We present a case of out-of-hospital cardiac arrest due to ventricular fibrillation (VF) in a patient without obstructive coronary disease but with a small coronary artery fistula. The case underscores the successful use of targeted temperature management (TTM) for neurological recovery and highlights the potential arrhythmogenic significance of even a small coronary fistula.
