Complete heart block following occlusion of the first septal perforator after coronary stenting

Area of Science:

• Cardiology
• Interventional Cardiology
• Electrophysiology

Background:

• Percutaneous coronary intervention (PCI) is a common treatment for coronary artery disease.
• Complications of PCI, though rare, can significantly impact patient outcomes.
• Septal perforator artery occlusion is a recognized, albeit infrequent, complication of left anterior descending artery stenting.

Observation:

• A patient developed transient complete heart block immediately following stent deployment.
• The occlusion involved the first septal perforator branch of the left anterior descending coronary artery.
• The heart block manifested as a complete disruption of atrioventricular conduction.

Findings:

• Successful temporary transvenous pacing was initiated for the complete heart block.
• The patient demonstrated spontaneous resolution of atrioventricular conduction abnormalities.
• Normal sinus rhythm and atrioventricular conduction were restored within 3 days post-procedure.

Implications:

• This case highlights a rare but significant complication of left anterior descending artery stenting.
• Prompt recognition and management, including temporary pacing, are crucial for favorable outcomes.
• Understanding this complication aids in risk assessment and management strategies for interventional cardiologists.