High-Grade Atrioventricular Block Caused by His-Purkinje Injury During Contrast Left Ventriculography

A 68-year-old woman with exertional chest discomfort was referred for cardiac catheterization. Her medications did not include atrioventricular (AV) nodal blocking agents, and she had no prior history of dizziness or syncope. Her admission ECG was normal, including a normal axis, PR interval, and QRS morphology and duration (Figure 1). Right heart catheterization and coronary angiography demonstrated normal right heart pressures, mild luminal irregularities in the left anterior descending coronary artery, a discrete 50% stenosis in the left circumflex coronary artery, and normal right coronary artery. A 6-French, 145-degree, angled pigtail catheter with end holes and multiple side …