Less Is More: A Case of Delayed Return of Normal Conduction

Conduction disturbances are a well-recognized complication of acute myocardial infarction (MI), particularly when the infarct involves the inferior wall and jeopardizes blood flow to the atrioventricular node. An 82-year-old woman admitted for symptomatic anemia developed an inferior myocardial infarction complicated by 2:1 atrioventricular block, later progressing to complete heart block. She underwent percutaneous intervention for a critical distal right coronary artery lesion and required temporary transvenous pacing. Although permanent pacemaker implantation was initially considered, the procedure was delayed due to concurrent management of hemorrhagic cystitis, allowing for extended observation. During this period, her native atrioventricular conduction fully recovered, and she remained stable after removal of the temporary pacemaker, with an implantable cardiac monitor placed for follow-up. This case demonstrates that conduction recovery after inferior MI may occur beyond the standard 72-hour window and supports prolonged monitoring to avoid unnecessary pacemaker implantation in appropriate patients.