The atrioventricular nodal artery supplies the AV node, the compact structure at the base of the interatrial septum that delays conduction between the atria and ventricles. It arises from the dominant coronary artery at the crux cordis (posterior interventricular groove): from the right coronary artery in right-dominant individuals (approximately 90%) and from the left circumflex in left-dominant individuals (approximately 10%).
Occlusion of the AV nodal artery in the context of inferior STEMI produces varying degrees of AV block: first degree, Wenckebach (type I second degree), or complete (third degree) AV block. Inferior MI with complete heart block requires temporary transvenous pacing while waiting for reperfusion; unlike anterior MI-associated complete block (from His-Purkinje injury), inferior MI AV block usually resolves after successful reperfusion. In left-dominant individuals, a posterolateral circumflex occlusion may produce the same AV nodal ischaemia.
Inferior STEMI occluding the right coronary artery proximal to the AV nodal branch produces complete AV block with ventricular escape rhythm and haemodynamic compromise; temporary transvenous pacing provides haemodynamic support until primary PCI restores AV nodal perfusion and block typically resolves within days.
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