Reversible High-Grade AV Block in Cardiogenic Shock: A Case Report
Abstract
High-grade atrioventricular (AV) block is typically managed with permanent pacemaker implantation when not attributable to reversible causes. Current guidelines recommend permanent pacing for acquired second-degree Mobitz type II, high-grade, or third-degree AV block unless due to a reversible or physiologic cause. Inferior wall acute myocardial infarction (MI) is a well-recognized reversible cause of AV block that may resolve after revascularization. However, the reversibility of high-grade AV block in patients with coronary artery disease (CAD) but without acute MI is not well described. We present a case of an 81-year-old man with end-stage renal disease and cardiomyopathy who developed high-grade AV block in the setting of cardiogenic shock and significant left main and left anterior descending coronary disease. In this case his AV block resolved with aggressive volume optimization via continuous renal replacement therapy prior to coronary revascularization, suggesting transient AV nodal ischemia can be secondary to hypo-perfusion and severe volume overload. This case highlights the importance of optimizing hemodynamics and correcting reversible causes before proceeding with permanent pacemaker implantation.
Start Time
15-4-2026 1:30 PM
End Time
15-4-2026 4:30 PM
Room Number
Culp Ballroom 316
Poster Number
54
Presentation Type
Poster
Presentation Category
Health
Student Type
Graduate and Professional Degree Students, Residents, Fellows
Faculty Mentor
Morgan Randall
Reversible High-Grade AV Block in Cardiogenic Shock: A Case Report
Culp Ballroom 316
High-grade atrioventricular (AV) block is typically managed with permanent pacemaker implantation when not attributable to reversible causes. Current guidelines recommend permanent pacing for acquired second-degree Mobitz type II, high-grade, or third-degree AV block unless due to a reversible or physiologic cause. Inferior wall acute myocardial infarction (MI) is a well-recognized reversible cause of AV block that may resolve after revascularization. However, the reversibility of high-grade AV block in patients with coronary artery disease (CAD) but without acute MI is not well described. We present a case of an 81-year-old man with end-stage renal disease and cardiomyopathy who developed high-grade AV block in the setting of cardiogenic shock and significant left main and left anterior descending coronary disease. In this case his AV block resolved with aggressive volume optimization via continuous renal replacement therapy prior to coronary revascularization, suggesting transient AV nodal ischemia can be secondary to hypo-perfusion and severe volume overload. This case highlights the importance of optimizing hemodynamics and correcting reversible causes before proceeding with permanent pacemaker implantation.
