JACC. Case reports · 2026
Alternating Bundle Branch Block Despite a Patent Stent in Late-Presenting Extensive Anterior STEMI.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
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Alsagaff Mochamad Y, Ghea Cornelia, Susilo Hendri, Medistya Putri Elisabeth Sekaringtyas
Аннотация
BACKGROUND: Alternating bundle branch block (ABBB) is a rare but high-risk marker of advanced infra-Hisian disease and impending high-grade atrioventricular (AV) block in anterior ST-segment elevation myocardial infarction (STEMI).
CASE SUMMARY: A 39-year-old male smoker presented 19 hours after chest pain onset with extensive anterior STEMI and ABBB. Ostial left anterior descending artery occlusion was treated with overlapping drug-eluting stents, achieving TIMI flow grade III. Despite patent stents, he developed delayed complete AV block. Temporary transvenous pacing restored hemodynamic stability, and AV conduction recovered within 24 hours.
DISCUSSION: Septal injury, edema, microvascular obstruction, or reperfusion injury can destabilize His-Purkinje conduction despite the presence of open epicardial arteries.
TAKE-HOME MESSAGE: ABBB warrants continuous monitoring and pacing readiness, even when angiography appears reassuring.
CASE SUMMARY: A 39-year-old male smoker presented 19 hours after chest pain onset with extensive anterior STEMI and ABBB. Ostial left anterior descending artery occlusion was treated with overlapping drug-eluting stents, achieving TIMI flow grade III. Despite patent stents, he developed delayed complete AV block. Temporary transvenous pacing restored hemodynamic stability, and AV conduction recovered within 24 hours.
DISCUSSION: Septal injury, edema, microvascular obstruction, or reperfusion injury can destabilize His-Purkinje conduction despite the presence of open epicardial arteries.
TAKE-HOME MESSAGE: ABBB warrants continuous monitoring and pacing readiness, even when angiography appears reassuring.