Key result
Proximal LAD PCI with jailed septal perforator occlusion triggers complete heart block requiring permanent pacing.
Why the study?
Complete heart block due to occlusion of a jailed septal perforator after PCI of proximal LAD is a rare and clinically significant complication.
Case Report (n=1)
Occlusion of a jailed septal perforator during proximal LAD PCI is a rare but significant complication that can lead to complete heart block requiring permanent pacing.
Highlights risk of delayed complications after jailed septal perforator occlusion; leaves open optimal PCI strategies pending validation.
A 70-year diabetic and hypertensive lady admitted with acute coronary syndrome (ACS) underwent coronary angiography, which showed severe diffuse disease of proximal left anterior descending (LAD). She underwent percutaneous coronay intervention (PCI) of proximal LAD artery that resulted in occlusion of jailed first septal perforator. She remained stable and asymptomatic and was shifted to Coronary Care Unit (CCU) after successful procedure. Approximately five hours later, patient developed complete heart block (CHB) and became hemodynamically unstable. Temporary pacemaker (TPM) was implanted and relook angiogram was performed, which showed patent stent. Patient remained dependent on TPM. After one week, permanent pacemaker was implanted and patient discharged in stable condition.
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Shah et al. (2018) conducted a case report in Acute coronary syndrome (n=1). Percutaneous coronary intervention of proximal LAD artery was evaluated. Percutaneous coronary intervention of the proximal LAD resulted in occlusion of a jailed first septal perforator, leading to complete heart block requiring permanent pacemaker implantation.
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