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Document Type

Case Report

Abstract

Complete atrioventricular (AV) block, though uncommon in heart transplant recipients, is a potentially life-threatening condition that demands rapid diagnosis and management in the acute care setting. During complete AV block, there is a failure of electrical conduction from the atria to the ventricles resulting in the independent and dyssynchronous contraction of the heart chambers. Due to the resultant decrease in cardiac output, patients may experience lightheadedness, fatigue, shortness of breath, syncope and near syncope, and, in severe cases, cardiogenic shock may develop. A 58-year-old female with past medical history including hypertension, diabetes, chronic kidney disease, and congestive heart failure and prior heart and renal transplants on chronic immunosuppression presented to the emergency department (ED) for near syncope. The initial electrocardiogram (EKG) revealed complete AV block with a ventricular rate of 40 beats per minute. Shortly after arrival, the patient became unresponsive. The patient received atropine and transcutaneous pacing was initiated with successful electrical and mechanical capture. The patient regained consciousness and during reassessment was found to be alert and oriented. She was transferred to a tertiary care center, where inpatient workup revealed no evidence of ischemic or structural cardiac pathology. A transvenous pacer was placed, and the patient was effectively discharged. One month following hospital discharge, the patient re-presented to the ED for palpitations. Pacemaker interrogation demonstrated no abnormalities, however, endomyocardial biopsy revealed mild acute cellular rejection prompting reconciliation and optimization of immunosuppression therapy. Complete AV block is a rare but emergent complication in heart transplant recipients, often linked to chronic rejection, acute infection, surgical trauma, or transplant vasculopathy. Prompt recognition and intervention are critical. This case report discusses potential etiologies and underscores the importance of multidisciplinary coordination in the management of complete AV block in the subpopulation of heart transplant recipients.

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