Spontaneous coronary artery dissection(SCAD) is a rare cause of acute coronary syndrome(ACS) with medical management and conservative therapies usually resulting in favorable outcomes. SCAD often is recurrent especially in high risk individuals with underlying connective tissue disorders. Lethal ventricular arrhythmias have been reported in SCAD without clear indications for secondary prevention with implantable cardiovert-defibrillator(ICD). Depending on risk factor for recurrence as well as susceptibility towards ventricular arrhythmias some patients may benefit from early implantations of ICDs.