Author`s Reply

To the Editor,

We appreciated the valuable comments on implantable cardioverter defibrillator (ICD) therapy in our patients with spontaneous coronary artery dissection (SCAD) (1). We did not consider ICD implantation for two reasons: 1. Cardiac arrest occurred in the setting of ongoing ischemia, which was relieved by coronary revascularization; 2. Left ventricular ejection fraction (LVEF) was, at the time of the acute event, 40% to 45% and subsequently recovered to normal. It is notable that in the large prospective Canadian registry including 750 SCAD patients, mean LVEF at presentation was 55%, and only 3.8% of patients had LVEF <35% (2). In case of persistent severely impaired LVEF following revascularization in a patient with SCAD, we would have first considered a wearable cardioverter defibrillator. If there was persistent LV dysfunction beyond 40 days due to large myocardial infarction, we would have then recommended an ICD as in any post-myocardial infarction patient. However, we acknowledge that, as stated in the 2018 American Heart Association SCAD scientific statement, the role of wearable cardioverter defibrillators as well as of ICD implantation in patients presenting with sudden cardiac arrest temporally related to ischemia has not been studied (3).