[A case of foxhole-shaped left ventricular abnormality induced by complete atrioventricular block with delayed...

An 86-year-old woman suffered sudden onset chest discomfort and dyspnea during sleep in the early morning of August 1, 2003. On admission, electrocardiography demonstrated complete atrioventricular block. Echocardiography showed severe hypokinesis in the left ventricular apex and hyperkinesis at the base. Serum cardiac deviant enzymes were slightly elevated. Based on these findings, acute myocardial infarction accompanied by complete atrioventricular block was suspected. Emergency coronary angiography performed under temporary pacing showed no significant stenosis in the coronary arteries. However, ventriculography demonstrated the presence of a foxhole-shaped left ventricular abnormality. A VDD type permanent pacemaker was implanted 5 days after the onset of the symptoms because the atrioventricular block had not improved. Following the implantation, pleural effusion and a temporary elevation of the body temperature occurred. The myocardial scintigraphy using 123I-metaiodobenzylguanidine (123I-MIBG) in the acute phase demonstrated extensive cardiac sympathetic nerve damage in the left ventricular apex. This condition was managed by medication including diuretics, angiotensin II receptor blocker and beta-blocker. Three months later, echocardiography and 123I-MIBG myocardial scintigraphy showed slight recovery of wall motion and sympathetic activity. However, mild pleural effusion persisted. A complete atrioventricular block was also present at this stage. In view of these findings, this case suggested that the foxhole-shaped left ventricular abnormality induced complete atrioventricular block with delayed recovery of wall motion.