The time to reversal of complete atrioventricular block and its predictors in acute ST-segment elevation myocardial infarction

Yadav, Satyavir; Yadav, Himanshu; Dwivedi, Sudhanshu Kumar; Parashar, Nitin Kumar; Chandra, Sharad; Chaudhary, Gaurav; Sethi, Rishi; Pradhan, Akshyaya; Vishwakarma, Pravesh; Sharma, Akhil; Bhandari, Monika; Ramakrishnan, Sivasubramanian; Karthikeyan, G.

doi:10.1016/j.jelectrocard.2020.10.008

Cited by 3 publications

(2 citation statements)

References 18 publications

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“…Complete AV block is registered two to four times mor*+e frequently in patients with STEMI of the inferior wall than in patients with different STEMI localization. According to data found in literature, around 28% of inferior wall STEMIs are complicated by complete AV block (2,3,4,5,6).…”

Section: Introductionmentioning

confidence: 99%

“…It is well known that complete AV block complicating STEMI is associated with less favorable in-hospital outcome, regardless of the location of the myocardial infarction (1,2,5,7,8). The prognostic impact of complete AV block on the long-term prognosis of patients with STEMI has not been determined with certainty, and individual authors state that it bears a greater significance in patients with anterior wall infarction than in patients with infarction localized elsewhere (1,3).…”

Section: Introductionmentioning

confidence: 99%

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The impact of the complete atrioventricular block on in-hospital and long-term mortality in patients treated with primary percutaneous coronary intervention

et al. 2023

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Objective: To analyze the incidence and the prognostic impact of complete AV block on in-hospital and 6-year mortality in STEMI patients treated with pPCI. Method: Study included 3044 consecutive STEMI patients. Results: Complete AV block was registered only at admission in 144 (4.73%) patients; 125 (86.8%) patients with complete AV block had inferior infarction. Temporary pacemaker was implanted in 72 (50%) patients with complete AV block. No patient underwent permanent pacemaker implantation. In-hospital mortality was significantly higher in patients with complete AV block than in patients without complete AV block: 17.9%vs3.6%, respectively, p<0.001. In patients with heart block and inferior infarction inhospital mortality was 13%, whereas in patients with heart block and anterior infarction inhospital mortality was 53%. When we analyzed patients who were discharged alive from the hospital, we also found significantly higher long-term (6-year) mortality rate in those with complete AV block vs patients without AV block: 7.8%v 3.4% respectively, p<0.001. Complete AV block was an independent predictor for in-hospital and 6-year mortality: inhospital mortality OR 2.94 95%CI 1.23-5.22; six year mortality HR 1.61, 95%CI 1.10- 2.37. When subanalysis was performed, in patients with inferior STEMI, complete AV block was an independent predictor of in-hospital and 6-year mortality, while in patients with anterior STEMI, complete AV block was an independent predictor of in-hospital mortality. Conclusion: In analyzed STEMI patients complete AV block was transitory and was registered only at hospital admission. Although transitory, complete AV block remained a strong independent predictor of in-hospital and long-term mortality.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The impact of the complete atrioventricular block on in-hospital and long-term mortality in patients treated with primary percutaneous coronary intervention

et al. 2023

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Management of pacemaker patients after myocardial infarction

Bryuhanova¹,

Горбунова²,

Bakovsky³

et al. 2021

Medicinskij sovet

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Myocardial infarction (MI) is the leading cause of death and disability in the population. Effective restoration of coronary blood flow in the infarction-dependent artery during percutaneous coronary intervention contributes to the regression of structural and functional remodeling of the left ventricle. Meanwhile, in 18% of cases, patients with myocardial infarction require implantation of a pacemaker because of the cardiac conduction disorders, among which atrioventricular blockade is the leading one. The need for pacemaker implantation is determined by the clinical features and the type of bradycardia complicating myocardial infarction. The scope of preventive measures at the stage of outpatient specialized cardiac care for patients with myocardial infarction and pacemaker includes medical, physical, and psychological rehabilitation. In addition, the presence of an implantable pacemaker necessitates specialized dynamic monitoring by an arrhythmologist, including programming the pacemaker. Performing a magnetic test allows to assess the efficiency of the pacemaker, the level of its charge and promptly determine the need to its replacement. Determination of the pacing threshold ensures efficient operation of the implantable device. After discharge from the hospital, a schedule for checking the pacemaker is determined, namely, 3 months after the date of implantation of the pacemaker, then 1-2 times a year. In the event of complaints of dizziness, fainting or damage of the pacemaker implantation site, the pacemaker check is carried out unscheduled. Patients with a history of myocardial infarction and an implantable pacemaker should be informed about the limitations that may be associated with the presence of a pacemaker. It is recommended to exclude contact with possible sources of electrical interference as much as possible, to avoid medical physiotherapy using galvanic currents. When using industrial or household equipment, safety precautions must be followed.

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Predictors of pacemaker implantation in patients with myocardial infarction and heart block

Bryukhanova

Горбунова

Мамчур

2022

Vestnik aritmologii

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The aim of the study was to identify predictors of early and delayed pacemaker (PM) implantation in patients with myocardial infarction (MI) and heart block, allowing the development of models for predicting the feasibility of its implantation.Methods. A randomized selection method was used to form a cohort of patients with MI complicated by cardiac conduction disorders. The first (control) group included 72 patients who did not have a PM implanted, the second (n=46) and third (n=68) groups consisted of patients with MI, having, respectively, indications for early (in the acute period of MI) and delayed (average after 3 years) PM implantation. All patients underwent endovascular revascularization of the infarct-dependent artery during hospitalization. Demographic, clinical, and morphological predictors of PM implantation in patients of the second and third groups were evaluated in comparison with the control group. Multiple logistic regression was used to identify factors associated with the need for PM implantation in the short term (hospital period) and in the long-term period.Results. Factors that determine the expediency of a permanent PM in the acute period of MI at the hospital stage, delayed pacemaker implantation 3.2±1.9 years after myocardial infarction, as well as predictors that do not require a permanent PM throughout the entire observation period, were identified. The main factors that require permanent PM implantation in the acute period were identified: 3rd degree atrioventricular (AV) block in NSTEMI, GRACE score 96 or higher, development of 3rd degree AV block in MI of any localization except postero-inferior. Predictors for the need for PM implantation after 3.2±1.9 years (delayed period) were STEMI of anterior localization; at the same time, age had an inversely proportional relationship in predicting the fact of permanent pacing. The factors that determine the need for PM implantation are the presence of anterior MI, the multiple coronary artery lesions.Conclusion. In the acute (hospital) period of NSTEMI, PM implantation is indicated at a high risk of adverse cardiovascular complications (GRACE scale of 96 points and above), in the presence of the 3rd degree AV block in any MI localization, except for the inferior one. Indications for permanent pacing 3.2±1.9 years after an acute coronary event are STEMI of anterior localization and multiple coronary artery lesions.

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The time to reversal of complete atrioventricular block and its predictors in acute ST-segment elevation myocardial infarction

Cited by 3 publications

References 18 publications

The impact of the complete atrioventricular block on in-hospital and long-term mortality in patients treated with primary percutaneous coronary intervention

The impact of the complete atrioventricular block on in-hospital and long-term mortality in patients treated with primary percutaneous coronary intervention

Management of pacemaker patients after myocardial infarction

Predictors of pacemaker implantation in patients with myocardial infarction and heart block

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