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Yin Q, Zhu P, Liu W, Gao Z, Zhao L, Wang C, Li S, Zhu M, Zhang Q, Zhang X, Wang C, Zhou J. A Conductive Bioengineered Cardiac Patch for Myocardial Infarction Treatment by Improving Tissue Electrical Integrity. Adv Healthc Mater 2023; 12:e2201856. [PMID: 36226990 DOI: 10.1002/adhm.202201856] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/14/2022] [Indexed: 02/03/2023]
Abstract
Conductive scaffolds are of great value for constructing functional myocardial tissues and promoting tissue reconstruction in the treatment of myocardial infarction (MI). Here, a novel scaffold composed of silk fibroin and polypyrrole (SP50) with a typical sponge-like porous structure and electrical conductivity similar to the native myocardium is developed. An electroactive engineered cardiac patch (SP50 ECP) with a certain thickness is constructed by applying electrical stimulation (ES) to the cardiomyocytes (CMs) on the scaffold. SP50 ECP can significantly express cardiac marker protein (α-actinin, Cx-43, and cTnT) and has better contractility and electrical coupling performance. Following in vivo transplantation, SP50 ECP shows a notable therapeutic effect in repairing infarcted myocardium. Not only can SP50 ECP effectively improves left ventricular remodeling and restore cardiac functions, such as ejection function (EF), but more importantly, improves the propagation of electrical pulses and promote the synchronous contraction of CMs in the scar area with normal myocardium, effectively reducing the susceptibility of MI rats to arrhythmias. In conclusion, this study demonstrates a facile approach to constructing electroactive ECPs based on porous conductive scaffolds and proves the therapeutic effects of ECPs in repairing the infarcted heart, which may represent a promising strategy for MI treatment.
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Affiliation(s)
- Qi Yin
- Beijing Institute of Basic Medical Sciences, Beijing, 100850, P. R. China
| | - Ping Zhu
- Department of Geriatrics, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100853, P. R. China
| | - Wei Liu
- Beijing Institute of Basic Medical Sciences, Beijing, 100850, P. R. China
| | - Zhongbao Gao
- Beijing Institute of Basic Medical Sciences, Beijing, 100850, P. R. China
| | - Luming Zhao
- Beijing Institute of Basic Medical Sciences, Beijing, 100850, P. R. China
| | - Chunlan Wang
- Beijing Institute of Basic Medical Sciences, Beijing, 100850, P. R. China
| | - Siwei Li
- Beijing Institute of Basic Medical Sciences, Beijing, 100850, P. R. China
| | - Miaomiao Zhu
- Beijing Institute of Basic Medical Sciences, Beijing, 100850, P. R. China
| | - Qi Zhang
- Beijing Institute of Basic Medical Sciences, Beijing, 100850, P. R. China
| | - Xiao Zhang
- Beijing Institute of Basic Medical Sciences, Beijing, 100850, P. R. China
| | - Changyong Wang
- Beijing Institute of Basic Medical Sciences, Beijing, 100850, P. R. China
| | - Jin Zhou
- Beijing Institute of Basic Medical Sciences, Beijing, 100850, P. R. China
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Nikus K, Birnbaum Y, Fiol-Sala M, Rankinen J, de Luna AB. Conduction Disorders in the Setting of Acute STEMI. Curr Cardiol Rev 2021; 17:41-49. [PMID: 32614749 PMCID: PMC8142368 DOI: 10.2174/1573403x16666200702121937] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 02/28/2020] [Accepted: 03/12/2020] [Indexed: 11/22/2022] Open
Abstract
ST-elevation myocardial (STEMI) is frequently associated with conduction disorders. Regional myocardial ischemia or injury may affect the cardiac conduction system at various locations, and neural reflexes or changes in the balance of the autonomous nervous system may be involved. Sinoatrial and atrioventricular blocks are more frequent in inferior than anterior STEMI, while new left anterior fascicular block and right bundle branch block indicate proximal occlusion of the left anterior descending coronary artery. New left bundle branch block is associated with multi-vessel disease. Most conduction disorders associated with STEMI are reversible with reperfusion therapy, but they may still impair prognosis because they indicate a large area at risk, extensive myocardial infarction or severe coronary artery disease. Acute STEMI recognition is possible in patients with a fascicular or right bundle branch block, but future studies need to define the cut-off values for ST depression in the leads V1-V3 in inferolateral MI and for ST elevation in the same leads in anterior STEMI. In the left bundle branch block, concordant ST elevation is a specific sign of acute coronary artery occlusion, but the ECG feature has low sensitivity.
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Affiliation(s)
- Kjell Nikus
- Address correspondence to this author at the Department of Cardiology, Heart Center, Tampere University Hospital, Ensitie 4, 33520 Tampere,
Finland; Tel: +358 50 5575 396; E-mail:
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Chen S, Hsieh MH, Li SH, Wu J, Weisel RD, Chang Y, Sung HW, Li RK. A conductive cell-delivery construct as a bioengineered patch that can improve electrical propagation and synchronize cardiomyocyte contraction for heart repair. J Control Release 2020; 320:73-82. [DOI: 10.1016/j.jconrel.2020.01.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/08/2020] [Accepted: 01/15/2020] [Indexed: 12/27/2022]
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Wellens HJ. An inferior myocardial infarction with conduction abnormalities. Heart Rhythm 2018; 15:151-152. [PMID: 29304949 DOI: 10.1016/j.hrthm.2017.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Hein J Wellens
- Cardiovascular Research Institute, Maastricht, The Netherlands.
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Obiagwu C, Ariyarajah V, Apiyasawat S, Spodick DH. Correlation of echocardiographic left atrial abnormality with myocardial ischemia during myocardial perfusion assessment in patients with left bundle branch block. Am J Cardiol 2013; 112:660-3. [PMID: 23773629 DOI: 10.1016/j.amjcard.2013.04.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 04/19/2013] [Accepted: 04/19/2013] [Indexed: 11/28/2022]
Abstract
Left atrial (LA) abnormality, an easily quantifiable parameter of left ventricular (LV) diastolic dysfunction, has been associated with cardiovascular risk. Because during myocardial perfusion study (MPS), the abnormal LV activation pattern in patients with left bundle branch block (LBBB) frequently induces perfusion defects, a clinical correlate of early myocardial ischemia such as LA enlargement could alleviate some of these inherent challenges. We prospectively studied 144 consecutive patients with LBBB who underwent MPS after screening for electrocardiographic and echocardiographic LA enlargement over a 6-month period. Of those, 114 had a positive MPS result. We found that LA size (p <0.0001) and P-wave duration (p = 0.001) were significantly increased in patients as the severity of the defects increased on MPS, whereas LV ejection fraction was decrementally reduced (p = 0.001). Importantly, LA size (≥43.5 mm; sensitivity 70%, specificity 89%) and P-wave duration (≥135 milliseconds; sensitivity 63%, specificity 90%) were greatest when the MPS defect was severe. In conclusion, the presence of LA enlargement appears significantly correlated with myocardial ischemia among patients with LBBB and could therefore assist during MPS interpretation among patients in whom MPS interpretation could be challenging.
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Affiliation(s)
- Chukwudi Obiagwu
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
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CODINI MICHELEA. Conduction Disturbances in Acute Myocardial Infarction: The Use of Pacemaker Therapy. ACTA ACUST UNITED AC 2008. [DOI: 10.1111/j.1540-8167.1983.tb01605.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Candell-Riera J, Oller-Martínez G, Pereztol-Valdés O, Castell-Conesa J, Aguadé-Bruix S, Soler-Peter M, Simó M, Santana-Boado C, Soler-Soler J. Usefulness of myocardial perfusion SPECT in patients with left bundle branch block and previous myocardial infarction. Heart 2003; 89:1039-42. [PMID: 12923022 PMCID: PMC1767805 DOI: 10.1136/heart.89.9.1039] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The diagnostic value of myocardial perfusion scintigraphy in patients with left bundle branch block (LBBB) and previous acute myocardial infarction has not been evaluated. OBJECTIVE To determine the utility of single photon emission computed tomography (SPECT) in patients with LBBB and previous acute myocardial infarction. METHODS Seventy two consecutive patients with permanent LBBB and previous acute myocardial infarction were studied with stress-rest SPECT using 99mTc compounds. The same stress procedures were followed in all patients: (1) exercise alone when it was sufficient; (2) exercise plus simultaneous administration of dipyridamole if exercise was insufficient. RESULTS In 26 of 28 patients (93%) who had a Q wave acute myocardial infarct before the development of LBBB, there was concordance between abnormal Q waves and rest SPECT in the localisation of myocardial necrosis (kappa = 0.836; p = 0.0001). In 48 patients who had coronary angiography, the positive predictive value of exercise (+dipyridamole) myocardial SPECT for the diagnosis of left anterior descending coronary artery stenosis was 93%, for left circumflex coronary artery stenosis, 96%, and for right coronary artery stenosis, 89%. Specificity values were 83%, 91%, and 69%, respectively. However, sensitivity (69%, 64%, and 89%) and negative predictive values (48%, 46%, and 82%) were suboptimal. CONCLUSIONS Rest myocardial perfusion SPECT with technetium compounds is useful for localising healed myocardial infarction in patients with LBBB, and exercise (+dipyridamole) SPECT has a high positive predictive value and specificity for the diagnosis of coronary stenosis in these patients.
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Affiliation(s)
- J Candell-Riera
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
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Barold SS. Narrow QRS Mobitz type II second-degree atrioventricular block in acute myocardial infarction: true or false? Am J Cardiol 1991; 67:1291-4. [PMID: 2035456 DOI: 10.1016/0002-9149(91)90943-f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Abstract
Although much of the current enthusiasm in the management of acute myocardial infarction is related to revascularization strategies, mechanical and electrical complications continue to pose a major threat to recovery in some patients. Some of the major complications of acute myocardial infarction are cardiogenic shock, rupture of the free wall and pseudoaneurysm, rupture of the ventricular septum, acute mitral regurgitation, right ventricular myocardial infarction, infarct expansion or extension, pericarditis and tamponade, peri-infarction hypertension, and tachyarrhythmias and bradyarrhythmias. For each of these complications, general guidelines for diagnosis and management are offered. Early, aggressive, and judicious treatment of these complications may substantially decrease the morbidity and mortality associated with acute myocardial infarction.
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MESH Headings
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/etiology
- Arrhythmias, Cardiac/therapy
- Cardiac Pacing, Artificial
- Cardiac Tamponade/etiology
- Cardiac Tamponade/therapy
- Combined Modality Therapy
- Heart Rupture/etiology
- Heart Rupture, Post-Infarction/diagnosis
- Heart Rupture, Post-Infarction/etiology
- Heart Rupture, Post-Infarction/therapy
- Hemodynamics/physiology
- Humans
- Mitral Valve Insufficiency/diagnosis
- Mitral Valve Insufficiency/etiology
- Mitral Valve Insufficiency/therapy
- Myocardial Infarction/complications
- Pericarditis/diagnosis
- Pericarditis/etiology
- Pericarditis/therapy
- Prognosis
- Recurrence
- Shock, Cardiogenic/diagnosis
- Shock, Cardiogenic/etiology
- Shock, Cardiogenic/therapy
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Affiliation(s)
- C J Lavie
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN
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Tate DA, Simpson RJ, Gettes LS. Bradycardia-dependent bundle branch block during Mobitz I second degree heart block. Chest 1989; 95:438-40. [PMID: 2914497 DOI: 10.1378/chest.95.2.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- D A Tate
- University of North Carolina School of Medicine, Division of Cardiology, Chapel Hill 27599
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Braat SH, Brugada P, Bär FW, Gorgels AP, Wellens HJ. Thallium-201 exercise scintigraphy and left bundle branch block. Am J Cardiol 1985; 55:224-6. [PMID: 3966386 DOI: 10.1016/0002-9149(85)90335-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Tavazzi L, Salerno JA, Chimienti M, Cobelli F, Ray M, Bobba P. Tachycardia-dependent and bradycardia-dependent intraventricular conduction defects in acute myocardial infarction: electrocardiographic, electrophysiologic, and clinical correlates. Am Heart J 1981; 102:675-85. [PMID: 7282512 DOI: 10.1016/0002-8703(81)90092-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Presence of rate-dependent (RD) intraventricular conduction defects (IVCD) was documented by inducing variations in heart rate in 30 acute myocardial infarction (AMI) patients (10 right bundle branch block, six left bundle branch block, 13 left anterior hemiblocks, and two left posterior hemiblocks). Five IVCDs were tachycardia-dependent (TD), 20 were bradycardia-dependent (BD), and six were both TD and BD. In TD blocks shortest cycles showing normal intraventricular conduction ranged from 410 to 1330 msec (697 +/- 84 SE); in BD blocks longest cycles with normal intraventricular conduction ranged from 450 to 1450 msec (962 +/- 52). In 60% of cases intermittent incomplete RD blocks were also present. In one patients RD-IVCD intermittency remained until discharge; in the others it lasted from 4 minutes to 10 days. Afterwards 19 RD-IVCDs disappeared and four became stable; six patients died during RD-IVCD intermittency period. Disappearance of RD block was preceded by gradual reduction in cycle length showing TD block and lengthening of cycles stopped beats with BD block. Serial observation of RD-IVCDs provides information about sequence of electrophysiologic effects on the intraventricular conduction system in clinical AMI.
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Castellanos A, Garcia HG, Rozanski JJ, Zaman L, Pefkaros K, Myerburg RJ. Atropine-induced multilevel block in acute inferior myocardial infarction. A possible indication for prophylactic pacing. Pacing Clin Electrophysiol 1981; 4:528-37. [PMID: 6169039 DOI: 10.1111/j.1540-8159.1981.tb06224.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The degree of A-V block increased after intravenous administration of atropine in 10 nondigitalized patients with acute inferior myocardial infarction who had narrow QRS complexes during periods of 1:1 A-V conduction. Short episodes of 3:1, 4:1 and 5:1 A-V block were seen to emerge: (a) in 6 patients, directly from Wenckebach periods; (b) in 3 patients, from alternating Wenckebach periods; and (c) in 1 patient, from a 3:2 Wenckebach period which led to a short-lived alternating Wenckebach period. Apparently, the predominance of the chronotropic effects on the sinus node over the dromotropic effects on the A-V node led to a tachycardia-dependent (more ischemic than vagal) process, exposing or producing multi- (two, three or four) level block involving the A-V node (and perhaps the His bundle). Subsequently, therapeutic pacing was instituted in 9/10 patients because they developed spontaneous symptomatic advanced A-V block. Therefore, it is possible that the early effects of atropine identified a narrowly-defined subset of patients in whom prophylactic pacing may be indicated. However, more studies are necessary to corroborate these assumptions.
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Tans AC, Lie KI, Durrer D. Clinical setting and prognostic significance of high degree atrioventricular block in acute inferior myocardial infarction: a study of 144 patients. Am Heart J 1980; 99:4-8. [PMID: 7350750 DOI: 10.1016/0002-8703(80)90308-7] [Citation(s) in RCA: 77] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
High degree AV block occurred in 144 of 843 patients consecutively admitted because of acute inferior myocardial infarction and was associated with more extensive myocardial damage and a higher mortality rate, as compared to those without AV block. Patients with power failure at the time of appearance of high degree AV block and a ventricular rate of less than 50 per minute, seemed to profit from pacemaker therapy. By contrast in patients with power failure and a ventricular rate of more than 50 per minute, pacemaker insertion did not affect immediate prognosis.
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Abstract
Eleven patients were studied and a total of 144 Wenckebach cycles in the AV node and 118 Wenckebach cycles in the His-Purkinje system were analysed to determine the incidence of typical and atypical Wenckebach periodicity, with particular emphasis on one variant of atypical Wenckebach that may simulate a Mobitz type II block. This pseudo-Mobitz II pattern was defined as a long Wenckebach cycle in which, at least, the last three beats of the cycle show relatively constant PR intervals (variation of no more than 0.02 s in surface leads and no more than 10 ms in His bundle electrograms) and in which the PR interval immediately following the blocked beat is shorter than the PR interval before the block by 0.04 s or more. Atypical Wenckebach cycles were found to be more common than the typical variety at both the AV node (67%) and His-Purkinje system (69%). The pseudo-Mobitz II pattern was seen in 19 per cent of atypical AV nodal Wenckebach periods and in 17 per cent of atypical His-Purkinje system Wenckebach cycles. The need to discern a 'classical' Mobitz II block from a pseudo-Mobitz II pattern, especially in the setting of an acute inferior myocardial infarction, is emphasised.
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Cohen HC, D'Cruz I, Arbel ER, Langendorf R, Pick A. Tachycardia and bradycardia-dependent bundle branch block alternans: clinical observations. Circulation 1977; 55:242-6. [PMID: 64318 DOI: 10.1161/01.cir.55.2.242] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Eleven patients with tachycardia-dependent, bradycardia-dependent, or "pseudobradycardia-dependent" bundle branch block (BBB) alternans were studied. This classification is based on the following criteria: 1) When alternans is initiated by a sudden acceleration in ventricular rate, or it appears with aberration of the second beat after a pause, the alternans is tachycardia-dependent and results from a 2:1 bidirectional block in the affected bundle branch. 2) When alternans begins with the aberrant complex terminating a pause it is bradycardia-dependent; such an alternans results from alternating bundle branch cycle lengths and refractoriness, possibly produced by alternating transseptal retrograde penetration of the affected bundle branch. 3) In cases referred to as "pseudobradycardia-dependent BBB" alternans, a change from alternans to persiscardia-dependent BBB" alternans, a change from alternans to persistent BBB occurs as the cycle lengthens; however, the disappearance of BBB with further increase of the cycle length proves the tachycardia-dependence of the conduction defect.
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Gupta PK, Lichstein E, Chadda KD. Heart block complicating acute inferior wall myocardial infarction. Chest 1976; 69:599-604. [PMID: 1269267 DOI: 10.1378/chest.69.5.599] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Heart block was noted in 60 (35 complete and 25 second-degree) of 410 patients with acute inferior wall myocardial infarction. This group with heart block was compared to a control group of 30 patients with acute inferior wall infarction without heart block. The incidences of prior myocardial infarction and hypertension, in addition to the highest level of serum creatine phosphokinase and a maximum degree of ST-segment elevation in the inferior leads, were all greater in patients with heart block, as compared to the controls. The incidences of various complications, including dizziness and syncope, transient hypotension, cardiogenic shock, and congestive heart failure, were also higher in the group with heart block, while sinus nodal distrubances and atrial arrhythmias occurred with equal frequency. The mortality in those with heart block was 28 percent compared to 13 percent for the control. It is concluded that patients with heart block complicating acute inferior myocardial infarction have a greater amount of myocardial necrosis, a higher incidence of complications, and a higher mortality. Insertion of a temporary pacemaker should be considered when specific indications are present and not routinely.
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