Complete Heart Block due to Occlusion of Jailed Septal Perforator after Percutaneous Coronay Intervention of Proximal Left Anterior Descending Artery.

A 70-year diabetic and hypertensive lady admitted with acute coronary syndrome (ACS) underwent coronary angiography, which showed severe diffuse disease of proximal left anterior descending (LAD). She underwent percutaneous coronay intervention (PCI) of proximal LAD artery that resulted in occlusion of jailed first septal perforator. She remained stable and asymptomatic and was shifted to Coronary Care Unit (CCU) after successful procedure. Approximately five hours later, patient developed complete heart block (CHB) and became hemodynamically unstable. Temporary pacemaker (TPM) was implanted and relook angiogram was performed, which showed patent stent. Patient remained dependent on TPM. After one week, permanent pacemaker was implanted and patient discharged in stable condition.