BACKGROUND Acute coronary syndrome (ACS) with high-grade atrioventricular block (HAVB) still has a poor mortality risk, even in the current percutaneous coronary intervention (PCI) era. However, early PCI for ACS with HAVB is associated with improved in-hospital survival and a 6-month survival similar to that of ACS without HAVB. CASE PRESENTATION A 70-year-old man was admitted to our hospital for ACS with HAVB. ECG showed complete AV block, complete right bundle branch block (CRBBB), and left axis deviation. Cardiac enzymes were elevated. He underwent temporary pacemaker insertion and coronary angiography, which showed severe stenosis of the proximal right coronary artery (RCA), 99% stenosis of the distal RCA with Thrombolysis in Myocardial Infarction (TIMI) grade 2 flow, and total occlusion of the proximal left anterior descending artery (LAD). We performed primary PCI in both the RCA and LAD, which resulted in TIMI grade 3 flow in both. After PCI, the HAVB recovered to normal sinus rhythm with CRBBB; a normal QRS interval returned within three days. The patient was discharged from the hospital without complications. CONCLUSION In this case of ACS with HAVB, early intensive coronary artery reperfusion resulted in long-term patient survival. The blood supply to the AV node and bilateral bundle branches is complex. Multivessel ischemia may compromise both primary and collateral blood flows to the AV node and septum, resulting in severe conduction impairment. Clinicians performing PCI should be aware of this anatomy and physiology.

中文翻译：

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急性冠状动脉综合征伴高度房室传导阻滞的经皮冠状动脉介入治疗期间连续心电图改变：一例报告。

背景技术即使在当前的经皮冠状动脉介入治疗（PCI）时代，具有高度房室传导阻滞（HAVB）的急性冠状动脉综合征（ACS）仍然具有较低的死亡风险。然而，与没有HAVB的ACS相似，早期含HAVB的ACS的PCI与改善的院内生存率和6个月生存率相关。病例介绍一名70岁的男性因HAVB ACS入院。心电图显示完整的房室传导阻滞，完整的右束支传导阻滞（CRBBB）和左轴偏差。心脏酶升高。他接受了临时起搏器插入和冠状动脉造影，显示右冠状动脉近端严重狭窄（RCA），远端RCA狭窄占99％，并伴有心肌梗塞溶栓（TIMI）2级血流和左前侧近端完全闭塞降动脉（LAD）。我们在RCA和LAD中都执行了主PCI，这两者都导致了TIMI 3级流。PCI后，HAB随CRBBB恢复到正常的窦性心律。在三天内返回了正常的QRS间隔。该患者出院无并发症。结论在这种带有HAVB的ACS病例中，早期密集的冠状动脉再灌注可以使患者长期存活。AV节点和双侧束支的血液供应很复杂。多支血管缺血可能会损害到AV结和隔膜的原发和侧支血流，从而导致严重的传导障碍。进行PCI的临床医生应了解这种解剖结构和生理状况。在三天内返回了正常的QRS间隔。该患者出院无并发症。结论在这种带有HAVB的ACS病例中，早期密集的冠状动脉再灌注可以使患者长期存活。AV节点和双侧束支的血液供应很复杂。多支血管缺血可能会损害到AV结和隔膜的原发和侧支血流，从而导致严重的传导障碍。进行PCI的临床医生应了解这种解剖结构和生理状况。在三天内返回了正常的QRS间隔。该患者出院无并发症。结论在这种带有HAVB的ACS病例中，早期密集的冠状动脉再灌注可以使患者长期存活。AV节点和双侧束支的血液供应很复杂。多支血管缺血可能会损害到AV结和隔膜的原发和侧支血流，从而导致严重的传导障碍。进行PCI的临床医生应了解这种解剖结构和生理状况。多支血管缺血可能会损害到AV结和隔膜的原发和侧支血流，从而导致严重的传导障碍。进行PCI的临床医生应了解这种解剖结构和生理状况。多支血管缺血可能会损害到AV结和隔膜的原发和侧支血流，从而导致严重的传导障碍。进行PCI的临床医生应了解这种解剖结构和生理状况。