Paroxysmal atrioventricular block during coronary revascularisation with ultrasound: a case report

The authors report the case of advanced atrioventricular block during a pro cedure of right coronary revascularisation with ultrasound. The different possible physiopathological mechanisms are discussed, Althoug h no formal conclusions can be drawn, certain features suggest a paroxysmal nodal conduction defect secondary to transient parasympathetic stimulation by the ultrasound, a stimulation triggered by a Bezold-Jarish type of card iac reflex or by direct local excitation of vagal fibres of the atrioventri cular node.