Sudden death in a patient with multiple left anterior descending coronary artery fistulas to the left ventricle

Coronary fistulas to cardiac chambers are an infrequent anomaly and usually are found casually. Although the majority of patients are asymptomatic, in rare cases it may cause coronary steal and cardiac ischemia. We present a patient with a left anterior descending coronary artery with multiple small fistulas to the left ventricle that suffered angina and an episode of ventricular fibrillation that required electrical cardioversion and an intracardiac defibrillator.