Spontaneous recovery of complete atrioventricular block complicating acute anterior wall ST elevation myocardial
Navaneetha Sasikumar1, Indra Kuladhipati2
1Department of Cardiology , Frontier Lifeline Hospital , Chennai, Tamil Nadu, India.
Insights
Complete atrioventricular block in ST elevation myocardial infarction can spontaneously resolve. Reversible causes, like artery reocclusion, indicate a better prognosis and may be treated with angioplasty, avoiding permanent pacemakers.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Complete atrioventricular block during anterior ST elevation myocardial infarction (STEMI) typically indicates a poor prognosis.
- This complication is often associated with extensive myocardial damage.
Purpose of the Study:
- To present a case of spontaneous resolution of complete atrioventricular block in STEMI.
- To discuss mechanisms of resolution and highlight a subgroup with better prognosis.
- To emphasize the role of coronary angiography in guiding management.
Main Methods:
- Case report of a patient with acute anterior STEMI and complete atrioventricular block.
- Discussion of spontaneous resolution and potential underlying mechanisms.
- Review of clinical features suggesting artery reocclusion and reperfusion.
Main Results:
- The patient experienced spontaneous resolution of complete atrioventricular block.
- Clinical findings suggested reocclusion of the infarct-related artery followed by spontaneous reperfusion.
- Coronary angiography was crucial for diagnosis and treatment decisions.
Conclusions:
- Complete atrioventricular block in STEMI may be reversible, particularly when caused by infarct-related artery reocclusion.
- Percutaneous coronary angioplasty can treat reversible ischemia from reocclusion.
- Considering reversible causes can prevent unnecessary permanent pacemaker implantation, especially in resource-limited settings.
Background:
Complete atrioventricular block complicating acute anterior wall ST elevation myocardial infarction (MI) is classically considered one of the worst prognostic indicators.
Methods:
We present the case of a gentleman who developed complete atrioventricular block during the course of acute anterior wall ST elevation MI, and had spontaneous resolution of the same. Mechanisms of spontaneous resolution of complete atrioventricular block in the setting of acute MI are discussed. Attention is drawn to a subgroup of patients, albeit a minority, who have a better prognosis owing to reversible causes than classically expected and seen.
Results:
Clinical features suggested that this patient had reocclusion of the infarct-related artery after thrombolysis on presentation and spontaneous reperfusion.
Conclusion:
Coronary angiography provides invaluable information for decision making in such clinical scenarios. Complete atrioventricular block due to reversible ischaemia produced by reocclusion of an infarct-related artery should be reversible by percutaneous coronary angioplasty of the infarct-related artery. We suggest that reversible causes be considered before attributing atrioventricular block to irreversible damage, which would require a permanent pacemaker implantation. This would be more significant in most of the developing world, where resources are scarce.
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