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Rescue Percutaneous Coronary Intervention for a Lethal "Jailed" Septal Perforator Branch to Resolve Delayed Complete
Yuhei Nojima1, Madoka Ihara1, Hidenori Adachi1
1Department of Cardiology, Nishinomiya Municipal Central Hospital.
Insights
Delayed complete atrioventricular (AV) block after percutaneous coronary intervention (PCI) for left anterior descending artery (LAD) occlusion can be treated. Rescue angioplasty of an occluded septal perforator branch (SPB) successfully resolved AV block, avoiding permanent pacemaker implantation.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Electrophysiology
Background:
- Delayed complete atrioventricular (AV) block is an infrequent complication following percutaneous coronary intervention (PCI) of the left anterior descending (LAD) artery.
- Occlusion of a septal perforator branch (SPB) is a potential, though uncommon, cause of this delayed complication.
Observation:
- A 74-year-old male developed complete AV block 78 hours after elective PCI for proximal LAD.
- The complication was associated with occlusion of the first major SPB.
- The patient required a temporary transvenous pacemaker.
Findings:
- Successful balloon angioplasty of the occluded "jailed" SPB was performed.
- The patient recovered from the complete AV block.
- Permanent pacemaker implantation was successfully avoided.
Implications:
- Highlights the importance of vigilant post-PCI monitoring for AV conduction disturbances.
- Suggests considering rescue PCI for occluded SPBs in managing complex AV block.
- Emphasizes the potential for non-invasive management of post-PCI AV block.
Abstract:
Delayed complete atrioventricular (AV) block associated with an occluded septal perforator branch (SPB) is an uncommon complication after performing percutaneous coronary intervention (PCI) for the left anterior descending coronary artery (LAD). Here we report the case of a 74-year-old man who underwent elective PCI for proximal LAD complicated with occlusion of the first major SPB and developed a complete AV block 78 hours after PCI was performed. The patient received a temporary transvenous pacemaker via the jugular vein and successfully underwent balloon angioplasty of the lethal "jailed" SPB, resulting in recovery from the complete AV block. Permanent pacemaker implantation was avoided. Our findings indicate the importance of postprocedural monitoring and consideration of rescue PCI for an occluded SPB in cases of complicated AV conduction disturbances.