Effective delayed percutaneous coronary intervention for advanced atrial ventricular block in patients with recent...

Area of Science:

• Cardiology
• Interventional Cardiology
• Electrophysiology

Background:

• Myocardial infarction (MI) can lead to advanced atrio-ventricular block (AVB).
• Standard treatment windows for MI complications are often within 12 hours.
• Atrio-ventricular conduction recovery is crucial for patient outcomes.

Observation:

• A 50-year-old male presented with MI 44 hours post-onset, developing advanced AVB resistant to atropine.
• Emergent coronary angiography revealed total proximal occlusion of the right coronary artery (RCA).
• Percutaneous coronary intervention (PCI) was performed on Day 5.

Findings:

• Immediate post-PCI, the patient's PR interval shortened from baseline to 0.25 s.
• Further PR interval shortening to 0.18 s was observed by Day 16.
• Successful atrio-ventricular conduction recovery was achieved through late reperfusion therapy.

Implications:

• Delayed PCI may be a viable therapeutic option for myocardial infarction patients presenting with advanced AVB beyond the conventional 12-hour window.
• This case challenges the established timeframes for intervention in MI-induced conduction abnormalities.
• Further research is warranted to explore the efficacy and safety of late reperfusion strategies in similar clinical scenarios.