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

Abstract

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.

High-grade heart block requiring transvenous pacing associated with multisystem inflammatory syndrome in children during the COVID-19 pandemic

“…While the development of conduction system abnormalities including high-grade heart block is a known complication of coronary ischemia, 11 fulminant myocarditis, 12 and Kawasaki Disease with severe coronary involvement, 13 this is the first case report describing high-grade heart block as a complication of MIS-C associated with SARS-CoV-2 requiring transvenous pacing. In 1 reported cohort of 186 MIS-C patients from the United States, 12% had an associated arrhythmia; however, no specifics regarding the types of arrhythmias seen were described in the publication.…”

High Degree Atrioventricular Block in Non-ST-Segment Elevation Myocardial Infarction (NSTEMI) and Role of Early Revascularization

“…The resolution of high degree AV block following RCA revascularization has been previously described, but this is the first case of HDAVB resolution in the presence of co-dominant coronary circulation in the setting of NSTEMI [2].…”

Bezold–Jarisch reflex-mediated asystole during dobutamine stress testing: a case report

“…In cases of dobutamine-induced asystole, evaluation by coronary angiography is key to ruling out inferior wall ischaemia, which can cause sinoatrial and atrioventricular nodal dysfunction. 13 In the patients described in this article, the asystole resolved with prompt management, and further workup was not indicative of other aetiologies. Paradoxical sinus deceleration occurring during dobutamine infusion occurs in 8% of patients.…”