Complete atrioventricular block associated with not apical but midventricular ballooning

Area of Science:

• Cardiology
• Cardiovascular Medicine
• Electrophysiology

Background:

• Midventricular ballooning, a variant of takotsubo cardiomyopathy, is less common than apical ballooning.
• Complete atrioventricular block can occur in cardiac emergencies but often resolves.
• The association between midventricular ballooning and persistent complete atrioventricular block is not well-documented.

Purpose of the Study:

• To report the first case of midventricular ballooning associated with persistent complete atrioventricular block.
• To highlight the potential need for pacemaker implantation in such cases.
• To contribute to the understanding of rare cardiac presentations.

Main Methods:

• Case report of an 86-year-old woman presenting with syncope and head injury.
• Diagnostic workup including electrocardiography, coronary angiography, and left ventriculography.
• Management involving temporary transvenous pacing and eventual permanent pacemaker implantation.

Main Results:

• Electrocardiography revealed complete atrioventricular block, giant negative T waves, and QT prolongation.
• Left ventriculography demonstrated midventricular ballooning without significant coronary artery disease.
• Complete atrioventricular block persisted despite temporary pacing and improvement in left ventricular wall motion, necessitating pacemaker implantation.

Conclusions:

• Complete atrioventricular block can persist after the improvement of left ventricular wall motion in patients with midventricular ballooning.
• Permanent pacemaker implantation may be required in cases of persistent complete atrioventricular block associated with midventricular ballooning.
• This case expands the clinical spectrum of midventricular ballooning and its associated complications.