A case of delayed complete atrioventricular block and cardiac arrest after percutaneous coronary intervention of left anterior descending coronary artery

Abstract

Delayed complete atrioventricular (AV) block due to jailed septal branch during percutaneous coronary intervention (PCI) of left anterior descending artery is a rare complication. Here, we present a case of an elderly male who developed episodes of complete AV block and cardiac arrest 2 days after transient occlusion of the septal branch during PCI, and received permanent pacemaker implantation. This case had shown first-degree AV block plus right bundle branch block before PCI, and the presence of these preexisting conduction abnormalities may have been the underlying mechanism by which the transient occlusion of jailed septal branch cause complete AV block.

Rescue Percutaneous Coronary Intervention for a Lethal "Jailed" Septal Perforator Branch to Resolve Delayed Complete Atrioventricular Block

“…We reviewed the English literature and found only eight published case reports on delayed complete AV block following "jailed"/occluded SPB of LAD (Table). [2][3][4][5][6][7][8][9] The occlusion of SPB can lead to angina, myocardial infarction, and conduction abnormalities. Various mechanisms have been proposed, including plaque shift, the snow-plow effect, and stent jailing of the side branch.…”

“…Most of the eight published cases demonstrated the following various conduction abnormalities at baseline: first-degree AV block, left bundle branch block, CRBBB, and LAFB. [2][3][4][5][6][7][8][9] To treat hypertrophic obstructive cardiomyopathy, a procedure known as "percutaneous transluminal septal myocardial ablation (PTSMA)," which results in SPB occlusion, can be used. Chang, et al concluded that left bundle branch block (odds ratio: 39; P = 0.002) and first-degree AV block (odds ratio: 14; P = 0.001) on base-line ECG are independent predictors of complete AV block after PTSMA.…”

“…Notably, five of the eight published cases required permanent pacemaker implantation. [2][3][4][5][6][7][8][9] Several studies have shown that the development of right axis deviation during AMI is associated with a poor prognosis. 18,19) In contrast, some studies have mentioned that the development of left axis deviation in AMI is associated with a good prognosis, and this supports our result.…”

“…1) Conversely, delayed complete atrioventricular (AV) block due to a "jailed"/occluded septal perforator branch (SPB) following PCI for the left anterior descending coronary artery (LAD) is considered an uncommon complication with few reported cases in the literature. [2][3][4][5][6][7][8][9] We describe the case of an elderly man who developed syncope because of complete AV block 3 days after PCI for LAD complicated with the occlusion of the first major SPB.…”

Clinical utility of percutaneous coronary intervention on left anterior descending stenosis in the setting of third-degree atrioventricular block due to inferior myocardial infarction: a case report

“…Previous reports have predominantly described third-degree AVB in the setting of inferior MI or even severe RCA stenosis without MI 4 . Cases of third-degree AVB secondary to anterior MI have also been described, albeit with different prognoses 5 , 6 . Additionally, there have been reports concerning the occurrence of third-degree AVB due to septal occlusion (i.e.…”