Reversible 2:1 Atrioventricular Block After Chronic Coronary Revascularization.

BACKGROUND

Atrioventricular (AV) conduction disturbances in elderly patients are often attributed to degeneration. However, myocardial ischemia may also cause AV block, which can be reversible with coronary revascularization.

CASE SUMMARY: A 77-year-old woman with diabetes and hypertension presented with recurrent syncope. A 7-day Holter monitor showed intermittent 2:1 AV block and asymptomatic paroxysmal atrial fibrillation. Cardiac computed tomography and coronary angiography revealed severe proximal and mid left anterior descending artery stenoses, located before the origin of the first septal branch and classified as Mosseri type IIB. She underwent percutaneous coronary intervention, with complete resolution of AV block. At the 30-month follow-up, she remained asymptomatic without recurrence, avoiding pacemaker implantation.

DISCUSSION: AV block in older adults is usually considered degenerative, but in selected cases it may result from reversible ischemia. In this case, critical left anterior descending artery stenoses likely caused transient AV block through impaired perfusion of the conduction system. Recovery after revascularization supported a functional mechanism.

TAKE-HOME MESSAGES: Critical coronary lesions may cause reversible AV block, and revascularization can restore conduction while avoiding unnecessary pacemaker implantation. Careful anatomical evaluation can identify patients who may benefit from revascularization without permanent pacing.