A case of delayed complete atrioventricular block and cardiac arrest after percutaneous coronary intervention of left an
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CASE REPORT
A case of delayed complete atrioventricular block and cardiac arrest after percutaneous coronary intervention of left anterior descending coronary artery Yasuhiro Hamatani • Takashi Unoki • Hisashi Ogawa • Nobutoyo Masunaga • Mitsuru Abe • Masaharu Akao
Received: 24 July 2013 / Accepted: 28 October 2013 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2013
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. Keywords Complete atrioventricular block Septal branch Side branch occlusion Percutaneous coronary intervention
Introduction Percutaneous coronary intervention (PCI) has become increasingly common over recent decades. Side branch occlusion is a possible complication of PCI [1]. However, delayed complete AV block due to side branch occlusion of the septal branch of left anterior descending artery (LAD) following LAD stenting is uncommon, with few reported cases in the literature. We describe the case of an elderly
Y. Hamatani (&) T. Unoki H. Ogawa N. Masunaga M. Abe M. Akao Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-Cho, Fushimi-Ku, Kyoto 612-8555, Japan e-mail: [email protected]
male who developed syncope due to complete AV block 2 days after PCI of LAD during which the septal branch of LAD was occluded.
Case report A 76-year-old male was receiving treatment for hypertension, dyslipidemia, and diabetes mellitus at our hospital. He was taking aspirin, thienopyridine, angiotensin receptor blocker, calcium channel antagonist, statin, metformin, and insulin. He had a history of smoking (20 cigarettes daily for 20 years). He did not have chest symptom either during exercise or at rest. An electrocardiogram (ECG) at rest revealed first-degree AV block and complete right bundle branch block (CRBBB) with ST depression at V4-6 (Fig. 1). Transthoracic echocardiography showed a preserved ejection fraction of left ventricle without local asynergy. He was unable to undergo exercise stress test because of lower back pain. He probably had asymptomatic coronary artery disease. Therefore, he was screened for coronary artery disease on a CT scan. Coronary CT angiography revealed severe stenosis in proximal LAD. Coronary angiography (CAG) was performed and demonstrated severe stenosis from the left main trunk (LMT) to proximal and mid LAD (Fig. 2a). He underwent elective PCI for the stenotic lesi
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