case_images: PMC6332980_01
case_images: The patient's ECG six months before her arrival at our emergency department with a complete heart block. Sinus rhythm with LBBB.
case_images: CRIC2018-2459691.001.jpg
case_images: PMC6332980_01_CRIC2018-2459691.001.jpg
case_images: fig1
case_images: She had a known and asymptomatic Left Bundle Branch Block (LBBB) and a normal echocardiogram on previous regular visits at her cardiologist (Figure 1).
case_images: The patient's ECG at presentation. Complete heart block with an atrial rate of approximately 120 bpm and a ventricular rate of 32 bpm.
case_images: CRIC2018-2459691.002.jpg
case_images: PMC6332980_01_CRIC2018-2459691.002.jpg
case_images: fig2
case_images: Bundle Branch Block (RBBB) morphology (Figure 2). Before the insertion of a temporary transvenous pacemaker, atropine 2 mg was administered intravenously as a bolus infusion.
case_images: The patient's 12-Lead ECG after intravenous atropine administration. Sinus rhythm with LBBB.
case_images: CRIC2018-2459691.003.jpg
case_images: PMC6332980_01_CRIC2018-2459691.003.jpg
case_images: fig3
case_images: Shortly after, sinus acceleration was observed and conversion of the complete AV block into 2nd degree AV block with 2 : 1 conduction (note that the blocked P waves are more visible in Lead V1) (Figure 3). LBBB, at approximately 72 bpm (Figure 3). Laboratory studies revealed a normal complete blood count, normal electrolytes, cardiac enzymes, and
case_images: The patient's discharge ECG before her transfer to a specialized center for pacemaker implantation. Sinus rhythm with LBBB.
case_images: CRIC2018-2459691.004.jpg
case_images: PMC6332980_01_CRIC2018-2459691.004.jpg
case_images: fig4
case_images: Hormone (TSH). The patient was immediately transferred to the cardiac intensive care unit, hemodynamically stable and under continuous ECG monitoring. Her stay at our clinic remained uneventful until her transfer to a specialized tertiary center for a permanent pacemaker implantation (Figure 4).
case_images: Coronary angiography which revealed no atherosclerotic lesions.
case_images: CRIC2018-2459691.005.jpg
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case_images: fig5
case_images: Apart from the implantation, a coronary angiography was performed which revealed normal coronary arteries without atherosclerotic lesions (Figure 5).