An Acute Anterior Reinfarction Complicating with Transient Symptomatic Total Atrioventricular Block
Acute stent thrombosis is a frequent cause of myocardial infarct (MI) after stent placement. Total atrioventricular (AV) block is frequently become the conductive disturbance complication of acute reinfarct. Inferior MI has Low long-term mortality and greater reversibility than anterior MI which has higher in-hospital and long-term mortality.
44 years man, came to emergency department Cardiovascular Centre Harapan Kita with altered mental status since 12 hours ago.
PPCI stenting at proximal LAD of his acute anterior MI 2 days ago. Patient had acute stent thrombosis then underwent urgent PCI at referring hospital. Patient present with blood pressure 57/30, heart rate 20 -30 with TAVB rhythm. Laboratory showed increased serum lactate level 5.2. Patient was diagnosed with Total AV block caused by MI. Patient was planned for emergency temporary pacemaker (TPM) implantation. After 24 hours close monitoring, the patient intrinsic rhythm resolved with spontaneous recovery. Patient was hemodynamically stable until discharge.
Stent thrombosis of proximal stent of LAD will cause TAVB because of the source of the distal portion of the AV node is originating from septal branch of LAD. It is caused by extensive necrosis with higher in-hospital and long-term mortality, often culminated in permanent pacemaker. However, spontaneous recovery of TAVB into sinus rhythm take place. This could be caused by transient reversible ischemia of infra nodal region of AV node which supplied by septal perforator branch
This case reporting a complete atrioventricular block during the course of acute anterior reinfarct and had spontaneous resolution of the AV block. Mechanisms of spontaneous resolution of complete AV block in the setting of acute MI is associated transient ischemia after occlusion of proximal LAD.
Keyword: Reinfarct, Stent Thrombosis, Total AV Block
1. Paweł Tyczyński et al. Early Stent Thrombosis. Postep Kardiol Inter 2014; 10, 4 (38): 221–225
2. Spencer FA, Jabbour S, et al. Two-Decade-Long Trends (1975–1997) In the Incidence, Hospitalization, and Long-Term Death Rates Associated with Complete Heart Block Complicating Acute Myocardial Infarction: a Community-Wide Perspective. Am Heart J 2003;145:500–7.
3. Nguyen HL, Lessard D, Spencer FA, Yarzebski J, Zevallos JC, Gore JM et al. Thirty-year Trends (1975–2005) in The Magnitude and Hospital Death Rates Associated with Complete Heart Block in Patients with Acute Myocardial Infarction: a Population-Based Perspective. Am Heart J 2008;156:227–33
4. M. Athar Sadiq. Irreversible Delayed Complete Heart Block Secondary to Jailed First Septal Perforator Following PCI of the Left Anterior Descending Coronary Artery. J Invasive Cardiology 2012;24:E13-E15
5. Nojima Y. Rescue Percutaneous Coronary Intervention for a Lethal “Jailed” Septal Perforator Branch to Resolve Delayed Complete Atrioventricular Block. International Heart Journal. 2019; 60: 457-461
6. S Kurisu, et al. Right Bundle-Branch Block in Anterior Acute Myocardial Infarction in the Coronary Intervention Era: Acute Angiographic Findings and Prognosis. International Journal of Cardiology 116 (2007) 57–61
7. U.J.O. Gang et al. High-degree Atrioventricular Block Complicating ST-Segment Elevation Myocardial Infarction in The Era of Primary Percutaneous Coronary Intervention. Europace (2012) 14, 1639–1645
8. Aplin M, Engstrøm T, Vejlstrup NG, et al.; TRACE Study Group. Prognostic importance of complete atrioventricular block complicating acute myocardial infarction. Am J Cardiology 2003; 92: 853–856
9. Rosa et al. Complete Atrioventricular Block in Acute Coronary Syndrome: Prevalence, Characterization and Implication on Outcome. European Heart Journal: Acute Cardiovascular Care. 1-6. 2017
10. S.M. Singh et al. High-Grade Atrioventricular Block in Acute Coronary Syndromes: Insights from the Global Registry of Acute Coronary Events. European Heart Journal (2015) 36, 976–983
11. Ram R, Devi KB, Chanu KJ, Devi T, Naorem S, Chongtham DS. Study of Conduction Blocks in Acute Myocardial Infarction. J Med Soc 2016;30:149-52
12. Sasikumar N et al. Spontaneous recovery of complete atrioventricular block complicating acute anterior wall ST elevation myocardial infarction. Heart Asia 2012:158–163
13. In-Chang Hwang, et al. Reversibility of Atrioventricular Block According to Coronary Artery Disease: Results of a Retrospective Study. Korean Circ. J 2012;42:816-822
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