case_images: PMC4063517_01
case_images: Electrocardiography study at admission (pace rhythm)
case_images: ARYA-10-059f1.jpg
case_images: PMC4063517_01_ARYA-10-059f1.jpg
case_images: f1-ARYA-10-059
case_images: Hospital, a referral medical care unit for cardiac electrophysio-logical study) with cardiac shock due to complete heart block [Echocardiography (ECG) findings: pace rhythm (Figure 1)]. He had a history of
case_images: Echocardiography findings at admission
case_images: ARYA-10-059f2.jpg
case_images: PMC4063517_01_ARYA-10-059f2.jpg
case_images: f2-ARYA-10-059
case_images: AV block (ventricular rate: 30, atrial rate: 60) 3 months prior to referral and he had undergone dual-Chamber permanent pacemaker (PPM) implantation. At echocardiography, which is shown in figure 2, he had severe left ventricular enlargement, less than 30% ejection fraction, normal right ventricular size with mild dysfunction, mild to moderate mitral valve regurgitation (2+), thick and calcified bicuspid AV with invasion to interventricular septum (with area of 1.4*1 cm), moderate to severe AI, severe AS, and dilated ascending aorta (aneurysm = 5 mm).