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

Abstract

Acute myocardial infarction (MI), particularly inferior MI, may be complicated by the occurrence of third-degree atrioventricular (AV) block. This block is usually temporary, but in some cases it will require a permanent pacemaker (PPM). We report a case of inferior MI and primary percutaneous coronary intervention (PCI) of the right coronary artery (RCA). The third-degree AV block persisted as a result of the no-reflow phenomenon after PCI on the RCA, only to resolve after a second PCI on the left anterior descending (LAD). Improvement in the perfusion of the AV node via the RCA after PCI on the LAD may be able to explain this finding. This case suggests that complete revascularization should be achieved before deciding on the implantation of a PPM.

Ischemia Possibly Associated with High Degree Atrioventricular Block

“…A small number of case-reports already indicate the relationship between revascularization and AV conduction restoration [2][3][4]. However, this relationship was not present in a case series of patients with delayed and partially incomplete coronary artery bypass graft surgery (CABG) revascularization [5].…”