Key result
Acute right coronary artery infarction and rotational atherectomy caused a transient increase in His-lead threshold and loss of capture, which normalized 2 weeks postrevascularization.
Case Report (n=1)
No
Acute right coronary artery infarction and rotational atherectomy can cause a transient rise in His-lead threshold and loss of capture, which may resolve post-revascularization.
Clinicians should monitor His-lead thresholds during acute RCA infarction with atherectomy; case report leaves open reversibility and need for prospective confirmation.
An 85-year-old male was admitted to our center with a non-ST elevation myocardial infarction. The patient had a dual-chamber pacemaker in situ with an atrial and His lead. A transient increase in His threshold and loss of nonselective capture occurred at the presentation of right coronary artery infarction, peaking during rotational atherectomy therapy causing loss of capture and complete atrioventricular block. A follow-up interrogation, 2 weeks postrevascularization, showed a return to a normal nonselective capture morphology and threshold measurements. Physicians should be aware of this complication in patients with His leads, particularly those with a history of coronary artery disease.
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Hall et al. (2019) conducted a case report in Non-ST elevation myocardial infarction in a patient with a His lead (n=1). Right coronary artery infarction and rotational atherectomy was evaluated on His threshold and capture. Acute right coronary artery infarction and rotational atherectomy caused a transient increase in His-lead threshold and loss of capture, which normalized 2 weeks postrevascularization.
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