Long-term prognosis after acute anterior infarction with atrioventricular block.

Abstract

The purpose of this study was to evaluate the need for permanent pacing in patients who have survived the effects of anterior myocardial infarction with complete heart block and have returned to sinus rhythm but who are left with impairment of intraventricular conduction. We reviewed. All had been referred with recent anterior myocardial infarction complicated by the development of complete heart block. It was not known whether there was pre-existing fascicular block before infarction. In 2 patients (Cases 3 and 6) a narrow QRS in the presence of complete heart block suggested proximal atrioventricular block. In all other patients the level of the block was considered to be distal in site because of the slow rate of the escape pacemaker and a QRS width of at least 0 12 s. All patients needed temporary pacing.The diagnosis of acute myocardial infarction was established by a typical history accompanied by characteristic enzyme rises and the development of pathological Q waves accompanied by ST segment and T wave changes in the anterior chest leads. Bundle-branch block was defined according to the criteria of Goldman (1967) and the criteria for hemiblock were those of Rosenbaum (1970). Partial bilateral bundle-branch block was defined as right bundle-branch block and left anterior hemiblock or right bundle-branch block and left posterior hemiblock.The usual hospital stay was at least 3 weeks and follow-up observations were obtained in all patients. His bundle electrograms were recorded in 8 patients after return to sinus rhythm, using the technique described by Scherlag et al. (1969). 186

ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities

“…66,126 -130 Patients with AMI who have intraventricular conduction defects, with the exception of isolated left anterior fascicular block, have an unfavorable short-and long-term prognosis and an increased risk of sudden death. 66,79,126,128,130 This unfavorable prognosis is not necessarily due to development of high-grade AV block, although the incidence of such block is higher in postinfarction patients with abnormal intraventricular conduction. 126,131,132 When AV or intraventricular conduction block complicates AMI, the type of conduction disturbance, location of infarction, and relation of electrical disturbance to infarction must be considered if permanent pacing is contemplated.…”

2012 ACCF/AHA/HRS Focused Update Incorporated Into the ACCF/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities

“…133 Despite the use of thrombolytic therapy and primary angioplasty, which have decreased the incidence of AV block in AMI, mortality remains high if AV block occurs. 130,[134][135][136][137] Although more severe disturbances in conduction have generally been associated with greater arrhythmic and nonarrhythmic mortality, [126][127][128][129]131,133 the impact of preexisting bundle-branch block on mortality after AMI is controversial. 112,133 A particularly ominous prognosis is associated with left bundle-branch block combined with advanced second-or third-degree AV block and with right bundle-branch block combined with left anterior or left posterior fascicular block.…”

“…66,[126][127][128][129][130] Patients with AMI who have intraventricular conduction defects, with the exception of isolated left anterior fascicular block, have an unfavorable shortand long-term prognosis and an increased risk of sudden death. 66,79,126,128,130 This unfavorable prognosis is not necessarily due to development of high-grade AV block, although the incidence of such block is higher in postinfarction patients with abnormal intraventricular conduction. When AV or intraventricular conduction block complicates AMI, the type of conduction disturbance, location of infarction, and relation of electrical disturbance to infarction must be considered if permanent pacing is contemplated.…”

2013 ESC Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy

“…El BAV de alto grado relacionado con infarto anterior se localiza más a menudo bajo el nodo AV w181 . El BAV que complica el infarto agudo de miocardio, a menudo se soluciona por sí solo pasados días o semanas [133][134][135][136] , y sólo el 9% de estos pacientes requieren estimulación cardiaca permanente 132 . Los pacientes con BAV tienen una mortalidad hospitalaria y a los 30 días mayor que aquellos con conducción AV conservada independientemente del sitio del infarto 133 .…”