Advanced atrioventricular block and left bundle branch block in a patient with coronary artery fistula

Coronary artery fistulas are abnormal vascular conduits, rarely related to atrioventricular conduction abnormalities. We report the case of a 52-year-old woman who presented with dyspnoea on exertion. Her ECG revealed advanced atrioventricular block and left bundle branch block. CT scans confirmed two fistulas, from the conus branch of right coronary artery and from the left anterior descending coronary artery, into the pulmonary artery. The patient underwent pacemaker implantation. To date, only nine patients with different degrees of heart blocks associated with coronary artery fistulas have been reported. Herein, we review and summarise previously reported cases of different degrees of heart blocks associated with coronary artery fistulas.

[1]  Changhu Liang,et al.  Coronary artery fistulas detected with coronary CT angiography: a pictorial review of 73 cases. , 2020, The British journal of radiology.

[2]  E. Chun,et al.  Coronary Artery Fistulas: Pathophysiology, Imaging Findings, and Management. , 2018, Radiographics : a review publication of the Radiological Society of North America, Inc.

[3]  D. Jain,et al.  Exercise induced complete atrioventricular block: Utility of exercise stress test. , 2017, Journal of electrocardiology.

[4]  F. Pinto,et al.  Coronary Fistulas in a Patient with a Novel Long QT Syndrome Mutation , 2015, Arquivos brasileiros de cardiologia.

[5]  J. Yip,et al.  Coronary Artery to Right Atrium Fistula Associated With First Degree Atrioventricular Block: A Rare Association , 2013, ASEAN heart journal : Official journal of the ASEAN Federation of Cardiology.

[6]  W. Haverkamp,et al.  Absent proximal right coronary artery with a fistula into the pulmonary vein. , 2012, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[7]  M. Yamagishi,et al.  Coronary arteriovenous fistulas complicated by complete atrioventricular block: A case report. , 2011, Journal of cardiology cases.

[8]  S. Juraschek,et al.  Heart Failure with Transient Left Bundle Branch Block in the Setting of Left Coronary Fistula , 2011, Cardiology research and practice.

[9]  J. Chachques.  Development of Bioartificial Myocardium Using Stem Cells and Nanobiotechnology Templates , 2010, Cardiology research and practice.

[10]  T. Turk,et al.  Coronary arteriovenous fistulas in the adults: natural history and management strategies , 2009, Journal of cardiothoracic surgery.

[11]  B. Vasavada,et al.  Coronary artery fistulas: clinical and therapeutic considerations. , 2006, International journal of cardiology.

[12]  D. Paladini,et al.  Hypoplastic left heart syndrome associated with left ventricle–coronary artery–pulmonary artery fistula: prenatal diagnosis and histological correlation , 2005, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[13]  Robert H. Anderson,et al.  The Morphology of the Specialized Atrioventricular Junctional Area: The Evolution of Understanding , 2002, Pacing and clinical electrophysiology : PACE.

[14]  G. Sangiorgi,et al.  Coronary artery fistulas: clinical consequences and methods of closure. A literature review. , 2001, Italian heart journal : official journal of the Italian Federation of Cardiology.

[15]  N. Yoshimoto,et al.  Coronary artery-pulmonary artery fistula originating from three major coronary branches associated with exertional chest pain and tachycardia-dependent left bundle branch block. , 1998, Japanese heart journal.

[16]  H. Boudoulas,et al.  Coronary artery fistulas in adults: incidence, angiographic characteristics, natural history. , 1995, Catheterization and cardiovascular diagnosis.

[17]  K. Tötterman,et al.  Thrombosed Coronary Artery Fistula as a Cause of Paroxysmal Atrial Fibrillation and Ventricular Arrhythmia , 1994, Cardiovascular surgery.

[18]  J. Tamargo,et al.  Ventricular tachycardia in a patient with congenital coronary arteriovenous fistula. , 1992, American heart journal.

[19]  W. Manning,et al.  Coronary arteriovenous fistula presenting as congestive heart failure. , 1992, Catheterization and cardiovascular diagnosis.

[20]  R. Hobbs,et al.  Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. , 1990, Catheterization and cardiovascular diagnosis.

[21]  Y. Sasaki,et al.  Coronary artery fistula with left or right ventricular communication and sinus-node dysfunction. , 1990, Texas Heart Institute journal.

[22]  J. Fast,et al.  Abnormal wall movements of the right ventricle and both atria in patients with pericardial effusion as indicators of cardiac tamponade. , 1986, European heart journal.

[23]  L. Gettes,et al.  Exercise-induced distal atrioventricular block. , 1983, Journal of the American College of Cardiology.

[24]  J. Lowe,et al.  Surgical Management of Congenital Coronary Artery Fistulas , 1981, Annals of surgery.

[25]  R. Anderson,et al.  Criss‐Cross Atrioventricular Relationships Producing Paradoxical Atrioventricular Concordance or Discordance: Their Significance to Nomenclature of Congenital Heart Disease , 1974, Circulation.