{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T09:30:04Z","timestamp":1787391004301,"version":"build-2736575974"},"reference-count":10,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T00:00:00Z","timestamp":1784419200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T00:00:00Z","timestamp":1784419200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:label\/>\n                    <jats:p>Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor is standard following PCI. Ticagrelor is increasingly preferred due to its potent, reversible platelet inhibition. While generally safe, ticagrelor has been associated with conduction abnormalities, including sinus pauses and atrioventricular (AV) block, though clinically significant bradyarrhythmias remain rare. We report a rare case of symptomatic 2:1 Mobitz type II AV block following ticagrelor initiation post\u2010PCI and emphasize the importance of timely recognition to avoid unnecessary pacemaker implantation. We describe a 68\u2010year\u2010old woman presenting with unstable angina. Coronary angiography revealed significant mid\u2010RCA disease, and PCI with a sirolimus\u2010eluting stent was performed successfully. She was discharged on aspirin and ticagrelor, without rate\u2010limiting drugs, as her baseline heart rate was 60 bpm. Two weeks later, she developed dizziness and dyspnea (NYHA III). ECG showed 2:1 Mobitz type II AV block with a ventricular rate of 40\u2009bpm. Repeat angiography confirmed a patent stent, and thyroid profile was normal. Holter monitoring corroborated persistent AV block. Ticagrelor was discontinued and replaced with clopidogrel, resulting in the restoration of sinus rhythm. On follow\u2010up, the patient remained asymptomatic with normal ECG findings. Ticagrelor can rarely induce clinically significant AV block even in the absence of other rate\u2010limiting drugs. Clinicians should maintain a high index of suspicion when post\u2010PCI patients on ticagrelor present with bradyarrhythmias. Withdrawal of ticagrelor should be considered before resorting to pacemaker implantation, thereby preventing unnecessary interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ccd.70748","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T03:34:53Z","timestamp":1784518493000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Ticagrelor Induced 2:1 Atrio\u2010Ventricular Block After Percutaneous Coronary Intervention to Right Coronary Artery"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4589-1611","authenticated-orcid":false,"given":"Siddhant","family":"Arora","sequence":"first","affiliation":[{"name":"Department of Cardiology Postgraduate Institute of Medical Education and Research Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1222-6827","authenticated-orcid":false,"given":"Yash Paul","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Cardiology Postgraduate Institute of Medical Education and Research Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prashant","family":"Panda","sequence":"additional","affiliation":[{"name":"Department of Cardiology Postgraduate Institute of Medical Education and Research Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samman","family":"Verma","sequence":"additional","affiliation":[{"name":"Department of Cardiology Postgraduate Institute of Medical Education and Research Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,19]]},"reference":[{"issue":"3","key":"e_1_2_11_2_1","first-page":"143","article-title":"Ticagrelor Use in Patients After Percutaneous Coronary Intervention: One Year Follow Up in a Community Hospital","volume":"12","author":"Mannumbeth Renjithlal S. L.","year":"2022","journal-title":"American Journal of Cardiovascular Disease"},{"issue":"19","key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"1908","DOI":"10.1016\/j.jacc.2010.11.056","article-title":"The Incidence of Bradyarrhythmias and Clinical Bradyarrhythmic Events in Patients With Acute Coronary Syndromes Treated With Ticagrelor or Clopidogrel in the PLATO (Platelet Inhibition and Patient Outcomes) Trial: Results of the Continuous Electrocardiographic Assessment Substudy","volume":"57","author":"Scirica B. M.","year":"2011","journal-title":"Journal of the American College of Cardiology"},{"issue":"3","key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"105","DOI":"10.14740\/cr560w","article-title":"Comparison of Clopidogrel With Prasugrel and Ticagrelor in Patients With Acute Coronary Syndrome: Clinical Outcomes From the National Cardiovascular Database ACTION Registry","volume":"8","author":"Khayata M.","year":"2017","journal-title":"Cardiology Research"},{"issue":"19","key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"1844","DOI":"10.1016\/j.jacc.2007.07.053","article-title":"Safety, Tolerability, and Initial Efficacy of AZD6140, the First Reversible Oral Adenosine Diphosphate Receptor Antagonist, Compared With Clopidogrel, in Patients With Non\u2010ST\u2010Segment Elevation Acute Coronary Syndrome: Primary Results of the DISPERSE\u20102 Trial","volume":"50","author":"Cannon C. P.","year":"2007","journal-title":"Journal of the American College of Cardiology"},{"issue":"11","key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1056\/NEJMoa0904327","article-title":"Ticagrelor Versus Clopidogrel in Patients With Acute Coronary Syndromes","volume":"361","author":"Wallentin L.","year":"2009","journal-title":"New England Journal of Medicine"},{"issue":"12","key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"4422","DOI":"10.1016\/S0735-1097(25)04906-X","article-title":"Ticagrelor Induced High\u2010Degree AV Block","volume":"85","author":"De Jesus M.","year":"2025","journal-title":"Journal of the American College of Cardiology"},{"key":"e_1_2_11_8_1","unstructured":"\u201cInternational Journal of Clinical Studies & Medical Case Reports [Internet] \u201d IJCMCR\u2010CR\u2010ID\u201000357 cited December 23 2025 https:\/\/ijclinmedcasereports.com\/ijcmcr-cr-id-00357\/."},{"key":"e_1_2_11_9_1","first-page":"17","article-title":"Ticagrelor\u2010Induced Complete Heart Block","author":"Farooq Z.","year":"2025","journal-title":"Cureus [Internet]"},{"issue":"5","key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"178","DOI":"10.12998\/wjcc.v5.i5.178","article-title":"Ticagrelor Therapy and Atrioventricular Block: Do We Need to Worry?","volume":"5","author":"Maria E. D.","year":"2017","journal-title":"World Journal of Clinical Cases"},{"issue":"3","key":"e_1_2_11_11_1","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1152\/physrev.1990.70.3.761","article-title":"Cardiovascular Purinoceptors","volume":"70","author":"Olsson R. A.","year":"1990","journal-title":"Physiological Reviews"}],"container-title":["Catheterization and Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.70748","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccd.70748","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.70748","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T03:34:56Z","timestamp":1784518496000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccd.70748"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,19]]},"references-count":10,"alternative-id":["10.1002\/ccd.70748"],"URL":"https:\/\/doi.org\/10.1002\/ccd.70748","archive":["Portico"],"relation":{},"ISSN":["1522-1946","1522-726X"],"issn-type":[{"value":"1522-1946","type":"print"},{"value":"1522-726X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,19]]},"assertion":[{"value":"2026-01-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"ccd.70748"}}