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. 2016:2016:1971803.
doi: 10.1155/2016/1971803. Epub 2016 Jan 26.

Reversibility of High-Grade Atrioventricular Block with Revascularization in Coronary Artery Disease without Infarction: A Literature Review

Rhanderson Cardoso  1 , Carlos E Alfonso  1 , James O Coffey  1
Affiliations

Reversibility of High-Grade Atrioventricular Block with Revascularization in Coronary Artery Disease without Infarction: A Literature Review

Rhanderson Cardoso et al. Case Rep Cardiol. 2016.

Abstract

Complete atrioventricular (AV) block is known to be reversible in some cases of acute inferior wall myocardial infarction (MI). The reversibility of high-grade AV block in non-MI coronary artery disease (CAD), however, is rarely described in the literature. Herein we perform a literature review to assess what is known about the reversibility of high-grade AV block after right coronary artery revascularization in CAD patients who present without an acute MI. To illustrate this phenomenon we describe a case of 2 : 1 AV block associated with unstable angina, in which revascularization resulted in immediate and durable restoration of 1 : 1 AV conduction, thereby obviating the need for permanent pacemaker implantation. The literature review suggests two possible explanations: a vagally mediated response or a mechanism dependent on conduction system ischemia. Due to the limited understanding of AV block reversibility following revascularization in non-acute MI presentations, it remains difficult to reliably predict which patients presenting with high-grade AV block in the absence of MI may have the potential to avoid permanent pacemaker implantation via coronary revascularization. We thus offer this review as a potential starting point for the approach to such patients.

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Figures

Figure 1
Figure 1
Two : one atrioventricular block in a patient with unstable angina prior to revascularization.
Figure 2
Figure 2
(a) Angiography revealed an 80% ostial stenosis in the right coronary artery; (b) right coronary artery after successful deployment of drug-eluting stent to ostial lesion.
Figure 3
Figure 3
Resolution of 2 : 1 AV block after revascularization; residual 1st-degree AV block (PR 220 ms).
See this image and copyright information in PMC

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