PMC10460276_01
(a) ECG of the patient at presentation. Third degree AV Block with a ventricular escape rhythm and a rate of 22/min. (b) ECG of the patient after percutaneous coronary intervention of the proximal LAD at the site of origin of a large first septal and smaller second and third septal perforator. Sinus rhythm with 1 : 1 AV conduction, right bundle branch block (RBBB) and left posterior fascicular block.
CRIC2023-6676757.001.jpg
PMC10460276_01_CRIC2023-6676757.001.jpg
fig1
AV block with a ventricular escape rhythm (Figure 1(a)). A bed side transthoracic echocardiography showed a normal left ventricular ejection fraction without any significant structural pathologies. Upon revascularization (Figure 2(c), Video 3), performed under temporary pacing, the patient surprisingly, reverted to 1 : 1 AV conduction, with a right bundle branch block (RBBB) and a left posterior fascicular block present (Figure 1(b)).
(a) and (b) Different angulations of the LAD stenosis at the site of origin of a large first and a smaller second and third septal perforator (arrow pointing to the lesion). (c) Result after predilatation, stent deployment and POT proximal to the first septal perforator.
CRIC2023-6676757.002.jpg
PMC10460276_01_CRIC2023-6676757.002.jpg
fig2
A severe stenosis of the proximal-to-mid LAD at the site of origin of a large first septal perforator (FSP) and a smaller second and third septal branch was revealed (Figures 2(a) and 2(b), Video 1, Video 2). Upon revascularization (Figure 2(c), Video 3), performed under temporary pacing, the patient surprisingly, reverted to 1 : 1 AV conduction, with a right bundle branch block (RBBB) and a left posterior fascicular block present (Figure 1(b)).