Resolution of complete heart block after revascularization of acute marginal branch of the right coronary artery

Bolorunduro, Oluwaseyi; Khouzam, Rami N.; Dishmon, Dwight A.

doi:10.5543/tkda.2014.91074

Cited by 4 publications

(4 citation statements)

References 4 publications

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“…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].…”

Section: Discussionmentioning

confidence: 99%

Ischemia Possibly Associated with High Degree Atrioventricular Block

Siamkouris,

Offers,

Schloesser

et al. 2023

Case Reports in Cardiology

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Conduction restoration in second- and third-degree atrioventricular (AV) block after revascularization in acute coronary syndrome (ACS) setting is well established, however this is not the case in non-ACS setting. We present a case of a patient referred for permanent pacemaker implantation, due to high degree AV block (HAVB), who restored his conduction possibly due to targeted revascularization. Thus, this case sheds insight in the reversibility potential of HAVB after revascularization in non-ACS patients, which although signified in current literature, is still far from being a recommendation, due to lack of robust scientific confirmation.

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Section: Discussionmentioning

confidence: 99%

Ischemia Possibly Associated with High Degree Atrioventricular Block

Siamkouris,

Offers,

Schloesser

et al. 2023

Case Reports in Cardiology

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“…Despite the revascularization of the proximal LAD and the small extent of myocardial damage evident on echocardiography, the patient had a recurrence of his AV block 48 hours after revascularization and removal of the temporary pacemaker. There have been many studies that report the reversibility of high degree atrioventricular block associated with myocardial infarction after revascularization [11-13], even if delayed [14-16]. This was the rationale behind the attempt to remove the temporary pacemaker and potentially avoid an unnecessary permanent pacemaker placement that might limit the patient’s career as a firefighter.…”

Section: Discussionmentioning

confidence: 99%

An Interesting Case of Atherosclerotic Occlusion of the First Septal Perforator in a Physically Young and Fit Individual Causing Complete Heart Block

Chahine

Thapa

Gajulapalli

et al. 2019

Cureus

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Complete heart block (CHB) is an unfortunate complication of an anterior and inferior myocardial infarction (MI). We present a case of an atherosclerotic occlusion of the first septal perforator leading to CHB requiring permanent pacemaker placement in a young patient. A 33-year-old healthy white male presented to the emergency department with an episode of syncope. His vitals were stable, and his physical exam was unremarkable. His electrocardiogram (EKG) showed CHB and ST elevations in V1, V2, and V3 suggestive of septal MI. He underwent emergent left heart catheterization which revealed significant stenosis of the proximal left anterior descending (LAD) artery, proximal diagonal artery, and the first septal perforator. An intervention was done with stent placement in the LAD and insertion of a temporary pacemaker. After removal of the temporary pacemaker two days later, the patient developed asystole with alternating bundle branch block which prompted immediate reinsertion of the temporary pacemaker which was replaced later with a permanent pacemaker. The patient was stable afterward and discharged. The persistent atherosclerotic occlusion of the first septal perforator prevented adequate perfusion of the conduction system, even after revascularization of the proximal LAD. In conclusion, it is essential to acknowledge that difficulty to revascularize an occluded septal perforator raises the need for a permanent pacemaker to prevent a CHB.

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“…Ischemic-mediated mechanical stretch and chemical substances stimulate receptors located in the inferior and posterior left ventricular walls [ 28 ]. These receptors lead to activation of nonmyelinated afferent C-fibers from the vagus nerve, which in turn result in increased vagal tone and bradyarrhythmia [ 28 , 29 ]. This mechanism is known as the Bezold-Jarisch reflex.…”

Section: Theoretical Mechanisms Of Av Block Reversibility In Coronmentioning

confidence: 99%

“…The AV block resolved after balloon angioplasty of this lesion. Because the acute marginal branch does not supply the AV node, the mechanism for third-degree AV block was attributed to the Bezold-Jarisch reflex triggered by inferior wall ischemia [ 29 ].…”

Section: Theoretical Mechanisms Of Av Block Reversibility In Coronmentioning

confidence: 99%

Reversibility of High-Grade Atrioventricular Block with Revascularization in Coronary Artery Disease without Infarction: A Literature Review

Cardoso

Alfonso

Coffey

2016

Case Reports in Cardiology

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Complete atrioventricular (AV) block is known to be reversible in some cases of acute inferior wall myocardial infarction (MI). The reversibility of high-grade AV block in non-MI coronary artery disease (CAD), however, is rarely described in the literature. Herein we perform a literature review to assess what is known about the reversibility of high-grade AV block after right coronary artery revascularization in CAD patients who present without an acute MI. To illustrate this phenomenon we describe a case of 2 : 1 AV block associated with unstable angina, in which revascularization resulted in immediate and durable restoration of 1 : 1 AV conduction, thereby obviating the need for permanent pacemaker implantation. The literature review suggests two possible explanations: a vagally mediated response or a mechanism dependent on conduction system ischemia. Due to the limited understanding of AV block reversibility following revascularization in non-acute MI presentations, it remains difficult to reliably predict which patients presenting with high-grade AV block in the absence of MI may have the potential to avoid permanent pacemaker implantation via coronary revascularization. We thus offer this review as a potential starting point for the approach to such patients.

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Resolution of complete heart block after revascularization of acute marginal branch of the right coronary artery

Cited by 4 publications

References 4 publications

Ischemia Possibly Associated with High Degree Atrioventricular Block

Ischemia Possibly Associated with High Degree Atrioventricular Block

An Interesting Case of Atherosclerotic Occlusion of the First Septal Perforator in a Physically Young and Fit Individual Causing Complete Heart Block

Reversibility of High-Grade Atrioventricular Block with Revascularization in Coronary Artery Disease without Infarction: A Literature Review

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