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The Heart Block Hat-Trick: A Case of Alternating First-, Second-, and Third-Degree Heart Blocks

Nicholas Huerta1, Salman Malik2, Christopher Haas1

  • 1MedStar Health Internal Medicine Residency Program, Baltimore, MD, USA.

Case Reports in Cardiology
|June 23, 2023
PubMed

Insights

This case study details a young man with alternating degrees of atrioventricular (AV) block. Left bundle branch area pacing (LBBAP) was successfully used for physiologic pacing.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Genetics

Background:

  • Idiopathic atrioventricular (AV) block is uncommon in young patients.
  • Alternating degrees of AV block (first, second, and third-degree) are exceptionally rare.

Observation:

  • A 39-year-old male presented with fluctuating degrees of AV block.
  • Extensive workup for the cause of the AV block yielded inconclusive results.

Findings:

  • The patient received a pacemaker for treatment.
  • Physiologic pacing was achieved using left bundle branch area pacing (LBBAP).

Implications:

  • This case highlights the potential for genetic factors in AV block.
  • Left bundle branch area pacing (LBBAP) emerges as a promising technique for physiologic pacing in complex AV block cases.

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