PMC7453273_01
Electrocardiogram revealing complete heart block with a ventricular escape at approximately 48 beats per minute.
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On assessment in the emergency department, the patient was found to be in complete heart block (CHB) with a ventricular escape of 48 bpm (Figure 1).
Transthoracic echocardiogram performed on presentation. Apical 4 chamber view, at end diastole (a) and end systolic (b) demonstrating left ventricular apical hypokinesis.
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The coronary angiogram revealed nonobstructive coronary artery disease, with a focal 50% stenosis in the midleft circumflex coronary artery (supplemental figure 2).
Cardiac catheterisation performed on day 9, left ventriculogram at end diastole (a) and end systole (b) demonstrating resolution of the apical hypokinesis.
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The left ventriculogram performed revealed near normalisation of the apical hypokinesis and an elevated end diastolic pressure of 20 mmHg (Figure 3).
Electrocardiogram following implantation of a dual chamber pacemaker with atrial sensed, ventricular paced complexes.
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Nine days after presentation, once the patient was able to lie flat without incident, a dual chamber Biotronik pacemaker was implanted, DDD 60-130 (Figure 4).