Background: Total atrioventricular block (TAVB) is frequently become the conductive disturbance complication of acute reinfarction. Inferior MI has low long-term mortality and greater reversibility than anterior MI which has higher in-hospital and long-term mortality. Case Illustration: 44 old years man underwent PPCI stenting at proximal LAD of his acute anterior MI 2 days before presentation at the previous hospital. Patient had acute stent thrombosis then underwent urgent PCI and developed TAVB with idioventricular escape. In emergency department Cardiovascular Centre Harapan Kita, patient develop loss of consciousness with blood pressure 57/30 mmHg, heart rate 30 bpm and TAVB rhythm. Laboratory showed increased serum lactate level 5.2. Patient was diagnosed with Total AV block caused by anterior MI. Patient was planned for emergency temporary pacemaker (TPM) implantation. After 24 hours close monitoring, the patient intrinsic rhythm resolved with spontaneous recovery. Patient was hemodynamically stable until discharge. Discussion: Stent thrombosis of proximal stent of LAD will cause TAVB because of the source of the distal portion of the AV node is originating from septal branch of LAD. Cardiogenic shock could be a manifestation of TAVB with idioventricular escape. It is caused by extensive necrosis with higher in-hospital and long-term mortality, often culminated in permanent pacemaker. However, spontaneous recovery of TAVB into sinus rhythm take place. This could be caused by transient reversible ischemia of infra nodal region of AV node which supplied by septal perforator branch in anterior infarction. Conclusion: Stent thrombosis of proximal stent of LAD will cause TAVB because of the source of the distal portion of the AV node is originating from septal branch of LAD. Cardiogenic shock could be a manifestation of TAVB with idioventricular escape. It is caused by extensive necrosis with higher in-hospital and long-term mortality, often culminated in permanent pacemaker. However, spontaneous recovery of TAVB into sinus rhythm take place. This could be caused by transient reversible ischemia of infra nodal region of AV node which supplied by septal perforator branch in anterior infarction © 2022 Indonesian Heart Association. All rights reserved.