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Coronary arteriovenous fistulas complicated by complete atrioventricular block: A case report

Kiyoo Mori1, Mitsuru Nagata1, Kotaro Oe2

  • 1Department of Internal Medicine, Houju Memorial Hospital, Nomi, Ishikawa, Japan.

Journal of Cardiology Cases
|December 12, 2018
PubMed

Insights

Coronary arteriovenous fistulas (CAVFs) can progress to complete atrioventricular (AV) block due to reduced blood flow to the AV node. This case highlights a rare complication of CAVF, necessitating pacemaker implantation.

Area of Science:

  • Cardiology
  • Cardiac Electrophysiology
  • Interventional Cardiology

Background:

  • Coronary arteriovenous fistulas (CAVFs) are rare congenital or acquired abnormalities.
  • Atrioventricular (AV) block is a condition affecting the heart's electrical conduction system.

Observation:

  • A patient with bilateral CAVFs experienced progression from first-degree to complete AV block over four years.
  • His bundle electrogram confirmed the complete AV block was at the AV nodal level.
  • Myocardial imaging revealed decreased perfusion in the inferoapical wall.

Findings:

  • Bilateral CAVFs originated from the AV nodal artery and the circumflex artery, draining into the right atrium.
  • The small size of the fistulas precluded surgical repair.
  • A permanent pacemaker was implanted to manage the complete AV block.

Implications:

  • This is the first reported case of CAVF complicated by complete AV block.
  • The AV block is presumed secondary to arterial abnormalities and chronic ischemia caused by a coronary steal phenomenon.
  • Understanding this association is crucial for managing patients with CAVF and conduction abnormalities.

Keywords:
Atrioventricular blockComputed tomographyCoronary arteriovenous fistula

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