Transcatheter Coil Embolization-Induced Transient Heart Block-A Case Report

Coronary artery fistulas are uncommon abnormalities. Large coronary artery fistulas may result in symptomatic heart failure and require treatment. Coil embolization is an acceptable alternative to surgery for patients with coronary fistula. Its complications include coil migration, hematoma, perforation of the vessel wall by the guidewires, and hemolysis. However, complete atrioventricular (AV) block induced by the procedure was not reported previously. We report a 56 year-old man, who suffered from severe dyspnea. Initially, acute coronary syndrome was suspected. A fistula originating from the left circumflex artery and drain into the coronary sinus was noted during cardiac catheterization. For the fistula, this patient underwent transcatheter embolization with coils. Complete AV block occurred just after embolization and temporary pacing was required. We proposed that coil embolization for coronary artery might influence the flow of normal branches near the fistula. If the AV nodal artery flow is compromised, heart block may develop. To deploy the coils more distally could decrease such complication.