Complete atrioventricular block associated with not apical but midventricular ballooning

Abstract

An 86-year-old woman was admitted to hospital with a head injury secondary to an episode of syncope associated with incontinence. Electrocardiography showed complete atrioventricular block, giant negative T waves in the precordial leads, and QT interval prolongation. Emergency coronary angiography showed no significant coronary stenosis, while left ventriculography demonstrated midventricular ballooning. Despite temporary transvenous pacing, her complete atrioventricular block persisted, but worsening of heart failure did not occur. Although left ventricular wall motion improved, complete atrioventricular block remained, so a pacemaker was implanted on day 18 after admission. There have been no previous reports of complete atrioventricular block associated with midventricular ballooning. This case demonstrates that complete atrioventricular block may persist after improvement of left ventricular wall motion in patients with midventricular ballooning and implantation of a pacemaker may be needed.<Learning objective: Some cases describe takotsubo-like cardiomyopathy with not apical but midventricular ballooning. This is the first case of midventricular ballooning and persistence of complete atrioventricular block after improvement of left ventricular wall motion that required implantation of a pacemaker.>