Case Report: Atrioventricular block deterioration during general anesthesia induction in a patient with coronary heart disease complicated by first-degree atrioventricular block and complete right bundle branch block

Coronary artery disease complicated by first-degree atrioventricular block and complete right bundle branch block suggests potential bilateral bundle branch involvement, substantially increasing the risk of severe conduction disturbances during the perioperative period. We report the case of a patient with severe coronary atherosclerosis whose preoperative electrocardiogram revealed first-degree atrioventricular block combined with complete right bundle branch block. Following induction of general anesthesia, the atrioventricular block deteriorated precipitously, prompting postponement of the elective procedure. The patient subsequently underwent successful distal subtotal radical gastrectomy with temporary pacemaker support. This case highlights that anesthesia induction may precipitate or exacerbate atrioventricular block in such patients. For individuals undergoing high-risk noncardiac surgery, comprehensive preoperative assessment of cardiac conduction system function, rigorous dynamic rhythm monitoring, and pre-established rescue strategies including temporary pacemaker placement are warranted.