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Case report: Pacemaker lost capture after acute myocardial infarction in a patient with left circumflex coronary

Zhihong Wu1, Jianjun Tang1, Qingyi Zhu1

  • 1Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, China.

Frontiers in Cardiovascular Medicine
|December 23, 2022
PubMed

Insights

A patient experienced cardiac arrest due to a blocked artery (STEMI). This led to pacemaker malfunction, which resolved after restoring blood flow, highlighting a link between coronary artery thrombus and pacing issues.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Interventional Cardiology

Background:

  • A 71-year-old female with a dual-chamber pacemaker presented with unstable angina.
  • Acute coronary syndrome (ACS) can present with complex manifestations.

Observation:

  • The patient suffered cardiopulmonary arrest due to ST-segment elevation myocardial infarction (STEMI).
  • Pacemaker malfunction, specifically loss of capture (high pacing threshold, low sensing), was diagnosed.
  • Coronary angiography revealed an extensive thrombus in the proximal left circumflex artery (LCX).

Findings:

  • Successful thrombus aspiration and reperfusion were performed.
  • Right ventricular lead pacing parameters normalized post-reperfusion.
  • The findings suggest the LCX thrombus, supplying the right ventricular septum, caused the pacing failure.

Implications:

  • This case highlights a potential complication of ACS involving pacemaker function.
  • Understanding the coronary supply to the ventricular septum is crucial in managing pacemaker-dependent patients with ACS.
  • Early diagnosis and intervention for coronary thrombus may prevent or resolve pacemaker dysfunction.

Keywords:
acute myocardial infarctionarrestfailure capturepacemakersudden cardiac death

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