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Yadav S, Yadav H, Dwivedi SK, Parashar NK, Chandra S, Chaudhary G, Sethi R, Pradhan A, Vishwakarma P, Sharma A, Bhandari M, Ramakrishnan S, Karthikeyan G. The time to reversal of complete atrioventricular block and its predictors in acute ST-segment elevation myocardial infarction. J Electrocardiol 2020; 63:129-133. [PMID: 33197717 DOI: 10.1016/j.jelectrocard.2020.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/06/2020] [Accepted: 10/18/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the time to reversal of complete AV block (CAVB) in ST-segment elevation myocardial infarction (STEMI) with various modalities of treatment and to examine the factors associated with early reversal of CAVB. METHODS We prospectively assessed the STEMI patients complicated by CAVB. The mean time to reversal of CAVB was analyzed and compared according to the treatment received. Multivariate logistic regression analysis was performed to find the predictors of mortality. RESULTS Of 3954 patients with STEMI, CAVB was present in 146(3.7%) patients. Inferior wall myocardial infarction (IWMI) was more commonly associated with CAVB than anterior wall myocardial infarction (AWMI) (74.7% vs 25.3%). The mean time to reversal of CAVB was 25.4 ± 35.5 h. It was significantly lower with the primary percutaneous coronary intervention (PCI) compared to thrombolysis (5.21 ± 10.54 vs 12.98 ± 17.14; p = 0.0001). Predictors of early reversal of CAVB were early presentation to hospital (<6 h) from symptom onset, presence of IWMI, any revascularization done, primary PCI performed in comparison to thrombolysis, and normal serum creatinine levels. The presence of older age, broader QRS complex, cardiogenic shock/heart failure, and elevated creatinine were independent predictors of mortality. The CAVB reverted in all the alive patients except one who required permanent pacemaker implantation. CONCLUSION CAVB is uncommon in STEMI and it recovers in a vast majority of surviving patients. The time to reversal of CAVB in STEMI is lower with primary PCI compared to thrombolysis. Outcomes are poor without revascularization in such patients.
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Affiliation(s)
- Satyavir Yadav
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Himanshu Yadav
- Department of Cardiology, King George Medical University, Lucknow, India
| | | | - Nitin Kumar Parashar
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sharad Chandra
- Department of Cardiology, King George Medical University, Lucknow, India
| | - Gaurav Chaudhary
- Department of Cardiology, King George Medical University, Lucknow, India
| | - Rishi Sethi
- Department of Cardiology, King George Medical University, Lucknow, India
| | - Akshyaya Pradhan
- Department of Cardiology, King George Medical University, Lucknow, India
| | | | - Akhil Sharma
- Department of Cardiology, King George Medical University, Lucknow, India
| | - Monika Bhandari
- Department of Cardiology, King George Medical University, Lucknow, India
| | | | - Ganeshan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Kawamura Y, Yokoyama H, Kitayama K, Miura N, Hamadate M, Nagawa D, Nozaka M, Nakata M, Nishizaki F, Hanada K, Yokota T, Yamada M, Higuma T, Tomita H. Clinical impact of complete atrioventricular block in patients with ST-segment elevation myocardial infarction. Clin Cardiol 2020; 44:91-99. [PMID: 33179796 PMCID: PMC7803372 DOI: 10.1002/clc.23510] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/25/2020] [Accepted: 11/02/2020] [Indexed: 11/11/2022] Open
Abstract
Complete atrioventricular block (CAVB) is a common complication of ST-segment elevation myocardial infarction (STEMI). Although STEMI patients complicated with CAVB had a higher mortality in the thrombolytic era, little is known about the impact of CAVB on STEMI patients who underwent primary percutaneous coronary intervention (PCI). The study aimed at evaluating the clinical impact of CAVB on STEMI patients in the primary PCI era. We consecutively enrolled 1295 STEMI patients undergoing primary PCI within 24 hours from onset. Patients were divided into two groups according to the infarct location: anterior STEMI (n = 640) and nonanterior STEMI (n = 655). The outcomes were all-cause death and major adverse cardiocerebrovascular events (MACCE) with a median follow-up period of 3.8 (1.7-6.6) years. Eighty-one patients (6.3%) developed CAVB. The incidence of CAVB was lower in anterior STEMI patients than in nonanterior STEMI (1.7% vs 10.7%, p < .05). Anterior STEMI patients with CAVB had a higher incidence of all-cause deaths (82% vs 20%, p < .05) and MACCE (82% vs 25%, p < .05) than those without CAVB. Although higher incidence of all-cause deaths was found more in nonanterior STEMI patients with CAVB compared with those without CAVB (30% vs 18%, p < .05), there was no significant difference in the incidence of MACCE (24% vs 19%). Multivariate analysis showed that CAVB was an independent predictor for all-cause mortality and MACCE in anterior STEMI patients, but not in nonanterior STEMI. CAVB is rare in anterior STEMI patients, but remains a poor prognostic complication even in the primary PCI era.
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Affiliation(s)
- Yosuke Kawamura
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiroaki Yokoyama
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kazutaka Kitayama
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Naotake Miura
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Misato Hamadate
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Daiki Nagawa
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masashi Nozaka
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masamichi Nakata
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Fumie Nishizaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kenji Hanada
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takashi Yokota
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masahiro Yamada
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takumi Higuma
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hirofumi Tomita
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Misumida N, Ogunbayo GO, Catanzaro J, Etaee F, Kim SM, Abdel‐Latif A, Ziada KM, Elayi CS. Contemporary practice pattern of permanent pacing for conduction disorders in inferior ST-elevation myocardial infarction. Clin Cardiol 2019; 42:728-734. [PMID: 31173380 PMCID: PMC6671775 DOI: 10.1002/clc.23210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Currently, there is no clear consensus regarding the optimal waiting period before permanent pacemaker implantation in patients with conduction disorders following an inferior myocardial infarction. HYPOTHESIS We aimed to elucidate the contemporary practice pattern of pacing, especially the timing of pacemaker implantation, for sinoatrial node and atrioventricular (AV) conduction disorders following an inferior ST-elevation myocardial infarction (STEMI). METHODS Using the National Inpatient Sample database from 2010 to 2014, we identified patients with a primary diagnosis of inferior STEMI. Primary conduction disorders were classified into: (a) high-degree AV block (HDAVB) consisting of complete AV block or Mobitz-type II second-degree AV block, (b) sinoatrial node dysfunction (SND), and (c) no major conduction disorders. RESULTS Among 66 961 patients, 2706 patients (4.0%) had HDAVB, which mostly consisted of complete AV block (2594 patients). SND was observed in 393 patients (0.6%). Among the 2706 patients with HDAVB, 267 patients (9.9%) underwent permanent pacemaker. In patients with HDAVB, more than one-third (34.9%) of permanent pacemakers were placed within 72 hours after admission. The median interval from admission to permanent pacemaker implantation was 3 days (interquartile range; 2-5 days) for HDAVB vs 4 days (3-6 days) for SND (P < .001). HDAVB was associated with increased in-hospital mortality, whereas SND was not. CONCLUSIONS In patients who developed HDAVB following an inferior STEMI, only one in 10 patients underwent permanent pacemaker implantation. Despite its highly reversible nature, permanent pacemakers were implanted relatively early.
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Affiliation(s)
- Naoki Misumida
- Gill Heart and Vascular Institute and Division of Cardiovascular MedicineUniversity of KentuckyLexingtonKentucky
| | - Gbolahan O. Ogunbayo
- Gill Heart and Vascular Institute and Division of Cardiovascular MedicineUniversity of KentuckyLexingtonKentucky
| | - John Catanzaro
- Devision of Cardiovascular MedicineUniversity of FloridaJacksonvilleFlorida
| | - Farshid Etaee
- Department of CardiologyUniversity of Texas Southwestern Medical CenterDallasTexas
| | - Sun Moon Kim
- Gill Heart and Vascular Institute and Division of Cardiovascular MedicineUniversity of KentuckyLexingtonKentucky
| | - Ahmed Abdel‐Latif
- Gill Heart and Vascular Institute and Division of Cardiovascular MedicineUniversity of KentuckyLexingtonKentucky
| | - Khaled M. Ziada
- Gill Heart and Vascular Institute and Division of Cardiovascular MedicineUniversity of KentuckyLexingtonKentucky
| | - Claude S. Elayi
- Devision of Cardiovascular MedicineUniversity of FloridaJacksonvilleFlorida
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Jayaram AA, Iype J, Karkera D, Rao SM, Devasiya T, Ramachandran P, Pai U, Samanth J, Paramasivam G. Prevalence of Coronary Artery Disease and Its Risk Factors in Patients Undergoing Permanent Pacemaker Implantation. INTERNATIONAL JOURNAL OF CARDIOVASCULAR PRACTICE 2019. [DOI: 10.29252/ijcp-25262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Aguiar Rosa S, Timóteo AT, Ferreira L, Carvalho R, Oliveira M, Cunha P, Viveiros Monteiro A, Portugal G, Almeida Morais L, Daniel P, Cruz Ferreira R. Complete atrioventricular block in acute coronary syndrome: prevalence, characterisation and implication on outcome. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2017; 7:218-223. [PMID: 28617040 DOI: 10.1177/2048872617716387] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim was to characterise acute coronary syndrome patients with complete atrioventricular block and to assess the effect on outcome. METHODS Patients admitted with acute coronary syndrome were divided according to the presence of complete atrioventricular block: group 1, with complete atrioventricular block; group 2, without complete atrioventricular block. Clinical, electrocardiographic and echocardiographic characteristics and prognosis during one year follow-up were compared between the groups. RESULTS Among 4799 acute coronary syndrome patients admitted during the study period, 91 (1.9%) presented with complete atrioventricular block. At presentation, group 1 patients presented with lower systolic blood pressure, higher Killip class and incidence of syncope. In group 1, 86.8% presented with ST-segment elevation myocardial infarction (STEMI), and inferior STEMI was verified in 79.1% of patients in group 1 compared with 21.9% in group 2 ( P<0.001). Right ventricular myocardial infarction was more frequent in group 1 (3.3% vs. 0.2%; P<0.001). Among patients who underwent fibrinolysis complete atrioventricular block was observed in 7.3% in contrast to 2.5% in patients submitted to primary percutaneous coronary intervention ( P<0.001). During hospitalisation group 1 had worse outcomes, with a higher incidence of cardiogenic shock (33.0% vs. 4.5%; P<0.001), ventricular arrhythmias (17.6% vs. 3.6%; P<0.001) and the need for invasive mechanical ventilation (25.3% vs. 5.1%; P<0.001). After a propensity score analysis, in a multivariate regression model, complete atrioventricular block was an independent predictor of hospital mortality (odds ratio 3.671; P=0.045). There was no significant difference in mortality at one-year follow-up between the study groups. CONCLUSION Complete atrioventricular block conferred a worse outcome during hospitalisation, including a higher incidence of cardiogenic shock, ventricular arrhythmias and death.
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Affiliation(s)
| | | | | | | | | | - Pedro Cunha
- Cardiology Department, Santa Marta Hospital, Portugal
| | | | | | | | - Pedro Daniel
- Cardiology Department, Santa Marta Hospital, Portugal
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Kim KH, Jeong MH, Ahn Y, Kim YJ, Cho MC, Kim W. Differential Clinical Implications of High-Degree Atrioventricular Block Complicating ST-Segment Elevation Myocardial Infarction according to the Location of Infarction in the Era of Primary Percutaneous Coronary Intervention. Korean Circ J 2016; 46:315-23. [PMID: 27275168 PMCID: PMC4891596 DOI: 10.4070/kcj.2016.46.3.315] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/10/2015] [Accepted: 08/27/2015] [Indexed: 11/23/2022] Open
Abstract
Background and Objectives The clinical implication of high-degree (second- and third-degree) atrioventricular block (HAVB) complicating ST-segment elevation myocardial infarction (STEMI) is ripe for investigation in this era of primary percutaneous coronary intervention (PCI). We sought to address the incidence, predictors and prognosis of HAVB according to the location of infarct in STEMI patients treated with primary PCI. Subjects and Methods A total of 16536 STEMI patients (anterior infarction: n=9354, inferior infarction: n=7692) treated with primary PCI were enrolled from a multicenter registry. We compared in-hospital mortality between patients with HAVB and those without HAVB with anterior or inferior infarction, separately. Multivariate analyses were performed to unearth predictors of HAVB and to identify whether HAVB is independently associated with in-hospital mortality. Results STEMI patients with HAVB showed higher in-hospital mortality than those without HAVB in both anterior (hazard ratio [HR]=9.821, 95% confidence interval [CI]: 4.946-19.503, p<0.001) and inferior infarction (HR=2.819, 95% CI: 2.076-3.827, p<0.001). In multivariate analyses, HAVB was associated with increased in-hospital mortality in anterior myocardial infarction (HR=19.264, 95% CI: 5.804-63.936, p<0.001). However, HAVB in inferior infarction was not an independent predictor of increased in-hospital mortality (HR=1.014, 95% CI: 0.547-1.985, p=0.901). Conclusion In this era of primary PCI, the prognostic impact of HAVB is different according to the location of infarction. Because of recent improvements in reperfusion strategy, the negative prognostic impact of HAVB in inferior STEMI is no longer prominent.
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Affiliation(s)
- Kyung Hwan Kim
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Young Jo Kim
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Myeong Chan Cho
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Wan Kim
- Division of Cardiology, Department of Internal Medicine Gwangju Veterans Hospital, Gwangju, Korea
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Reversibility of High-Grade Atrioventricular Block with Revascularization in Coronary Artery Disease without Infarction: A Literature Review. Case Rep Cardiol 2016; 2016:1971803. [PMID: 26925272 PMCID: PMC4746340 DOI: 10.1155/2016/1971803] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/10/2016] [Indexed: 11/17/2022] Open
Abstract
Complete atrioventricular (AV) block is known to be reversible in some cases of acute inferior wall myocardial infarction (MI). The reversibility of high-grade AV block in non-MI coronary artery disease (CAD), however, is rarely described in the literature. Herein we perform a literature review to assess what is known about the reversibility of high-grade AV block after right coronary artery revascularization in CAD patients who present without an acute MI. To illustrate this phenomenon we describe a case of 2 : 1 AV block associated with unstable angina, in which revascularization resulted in immediate and durable restoration of 1 : 1 AV conduction, thereby obviating the need for permanent pacemaker implantation. The literature review suggests two possible explanations: a vagally mediated response or a mechanism dependent on conduction system ischemia. Due to the limited understanding of AV block reversibility following revascularization in non-acute MI presentations, it remains difficult to reliably predict which patients presenting with high-grade AV block in the absence of MI may have the potential to avoid permanent pacemaker implantation via coronary revascularization. We thus offer this review as a potential starting point for the approach to such patients.
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Mehta LS, Beckie TM, DeVon HA, Grines CL, Krumholz HM, Johnson MN, Lindley KJ, Vaccarino V, Wang TY, Watson KE, Wenger NK. Acute Myocardial Infarction in Women: A Scientific Statement From the American Heart Association. Circulation 2016; 133:916-47. [PMID: 26811316 DOI: 10.1161/cir.0000000000000351] [Citation(s) in RCA: 758] [Impact Index Per Article: 94.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cardiovascular disease is the leading cause of mortality in American women. Since 1984, the annual cardiovascular disease mortality rate has remained greater for women than men; however, over the last decade, there have been marked reductions in cardiovascular disease mortality in women. The dramatic decline in mortality rates for women is attributed partly to an increase in awareness, a greater focus on women and cardiovascular disease risk, and the increased application of evidence-based treatments for established coronary heart disease. This is the first scientific statement from the American Heart Association on acute myocardial infarction in women. Sex-specific differences exist in the presentation, pathophysiological mechanisms, and outcomes in patients with acute myocardial infarction. This statement provides a comprehensive review of the current evidence of the clinical presentation, pathophysiology, treatment, and outcomes of women with acute myocardial infarction.
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Complete Heart Block Complicating ST-Segment Elevation Myocardial Infarction. JACC Clin Electrophysiol 2015; 1:529-538. [DOI: 10.1016/j.jacep.2015.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 08/12/2015] [Accepted: 08/17/2015] [Indexed: 11/23/2022]
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Singh SM, FitzGerald G, Yan AT, Brieger D, Fox KA, López-Sendón J, Yan RT, Eagle KA, Steg PG, Budaj A, Goodman SG. High-grade atrioventricular block in acute coronary syndromes: insights from the Global Registry of Acute Coronary Events. Eur Heart J 2014; 36:976-83. [DOI: 10.1093/eurheartj/ehu357] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 08/08/2014] [Indexed: 12/22/2022] Open
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Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation 2012; 127:e283-352. [PMID: 23255456 DOI: 10.1161/cir.0b013e318276ce9b] [Citation(s) in RCA: 378] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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12
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Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Tracy CM, Epstein AE, Darbar D, DiMarco JP, Dunbar SB, Estes NAM, Ferguson TB, Hammill SC, Karasik PE, Link MS, Marine JE, Schoenfeld MH, Shanker AJ, Silka MJ, Stevenson LW, Stevenson WG, Varosy PD. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2012; 61:e6-75. [PMID: 23265327 DOI: 10.1016/j.jacc.2012.11.007] [Citation(s) in RCA: 561] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Sasikumar N, Kuladhipati I. Spontaneous recovery of complete atrioventricular block complicating acute anterior wall ST elevation myocardial infarction. HEART ASIA 2012; 4:158-63. [PMID: 27326056 DOI: 10.1136/heartasia-2012-010186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/14/2012] [Indexed: 11/04/2022]
Abstract
BACKGROUND Complete atrioventricular block complicating acute anterior wall ST elevation myocardial infarction (MI) is classically considered one of the worst prognostic indicators. METHODS We present the case of a gentleman who developed complete atrioventricular block during the course of acute anterior wall ST elevation MI, and had spontaneous resolution of the same. Mechanisms of spontaneous resolution of complete atrioventricular block in the setting of acute MI are discussed. Attention is drawn to a subgroup of patients, albeit a minority, who have a better prognosis owing to reversible causes than classically expected and seen. RESULTS Clinical features suggested that this patient had reocclusion of the infarct-related artery after thrombolysis on presentation and spontaneous reperfusion. CONCLUSION Coronary angiography provides invaluable information for decision making in such clinical scenarios. Complete atrioventricular block due to reversible ischaemia produced by reocclusion of an infarct-related artery should be reversible by percutaneous coronary angioplasty of the infarct-related artery. We suggest that reversible causes be considered before attributing atrioventricular block to irreversible damage, which would require a permanent pacemaker implantation. This would be more significant in most of the developing world, where resources are scarce.
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Affiliation(s)
- Navaneetha Sasikumar
- Department of Cardiology , Frontier Lifeline Hospital , Chennai, Tamil Nadu, India
| | - Indra Kuladhipati
- Department of Cardiology, Ayursundra Advanced Cardiac Centre, Guwahati, Assam , India
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14
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Bradiarritmias y bloqueos de la conducción. Rev Esp Cardiol 2012; 65:656-67. [DOI: 10.1016/j.recesp.2012.01.025] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 01/20/2012] [Indexed: 11/19/2022]
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15
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Gang UJO, Hvelplund A, Pedersen S, Iversen A, Jons C, Abildstrom SZ, Haarbo J, Jensen JS, Thomsen PEB. High-degree atrioventricular block complicating ST-segment elevation myocardial infarction in the era of primary percutaneous coronary intervention. Europace 2012; 14:1639-45. [DOI: 10.1093/europace/eus161] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Yaqub Y, Perez-Verdia A, Jenkins LA, Sehli S, Paige RL, Nugent KM. Temporary Transvenous Cardiac Pacing in Patients With Acute Myocardial Infarction Predicts Increased Mortality. Cardiol Res 2012; 3:1-7. [PMID: 28357017 PMCID: PMC5358289 DOI: 10.4021/cr111w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2011] [Indexed: 11/04/2022] Open
Abstract
Background Temporary pacemakers (TP) are used in emergency situations for severe bradyarrhythmias secondary to acute myocardial infarction (AMI) and to non-AMI related cardiac disorders. TP have been studied previously in AMI patients treated with thrombolytic therapy; limited information is available on current outcomes in AMI patients treated with percutaneous coronary intervention. Methods We reviewed the indications, complications, and mortality associated with TP insertion over a four year period (2003 - 2007) at a university hospital. Results Seventy-three temporary pacemakers were inserted (47 men, 26 women) during this period. The mean age was 65.2 years. TP were used in 29 AMI patients (39.7 % of total) and 44 non-AMI patients (60.3% of total). The duration of TP use was 2.6 ± 0.4 days in the whole cohort, 2.46 % of all AMI patients (29/1180) admitted during this period required a TP. Six of these patients requiring a TP required a permanent pacemaker. Eight patients with AMI and a TP died (27.6%). In contrast 8.9 % of AMI patients not requiring a TP died (P < 0.01). There were no statistically significant differences between the AMI and non-AMI groups in the duration of temporary pacing (2.4 ± 0.6 days vs. 2.8 ± 0.4 days), in complications (27.6% vs. 29.5%), or in mortality (27.6% vs. 15.9%). The need for a permanent pacemaker (PPM) differed significantly between the AMI and non-AMI patients (20.7% vs. 54.5%; P < 0.05). Conclusion Our results indicate that AMI patients infrequently require a TP and that approximately 20% of these patients require a PPM. These results suggest that early revascularization of the conduction system with current interventional techniques has decreased the need for TP in AMI patients. However, this group requires more intensive monitoring as the mortality rate in this group of patients is significantly higher than the other AMI patients not requiring TP.
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Affiliation(s)
- Yasir Yaqub
- Department of Internal Medicine, Texas Tech University Health Science Center, USA
| | | | - Leigh A Jenkins
- Department of Internal Medicine, Texas Tech University Health Science Center, USA
| | - Shermila Sehli
- Department of Internal Medicine, Texas Tech University Health Science Center, USA
| | - Robert L Paige
- Department of Mathematics and Statistics, Texas Tech University, Lubbock Texas, USA
| | - Kenneth M Nugent
- Department of Internal Medicine, Texas Tech University Health Science Center, USA
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Clinical significance of late high-degree atrioventricular block in patients with left ventricular dysfunction after an acute myocardial infarction--a Cardiac Arrhythmias and Risk Stratification After Acute Myocardial Infarction (CARISMA) substudy. Am Heart J 2011; 162:542-7. [PMID: 21884874 DOI: 10.1016/j.ahj.2011.06.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 06/05/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND High-degree atrioventricular block (HAVB) is a frequent complication in the acute stages of a myocardial infarction associated with an increased rate of mortality. However, the incidence and clinical significance of HAVB in late convalescent phases of an AMI is largely unknown. The aim of this study was to assess the incidence and prognostic value of late HAVB documented by continuous electrocardiogram (ECG) monitoring in post-AMI patients with reduced left ventricular function. METHODS The study included 286 patients from the CARISMA study with AMI and left ventricular ejection fraction of 40% or less. An insertable loop recorder was implanted 5 to 21 days after AMI for incessant arrhythmia surveillance. Furthermore, ECG documentation was supplemented by a 24-hour Holter monitoring conducted at week 6 post-AMI. The clinical significance of HAVB occurring more than 21 days after AMI was examined with respect to development of major heart failure events and major ventricular tachyarrhythmic events. RESULTS During a median follow-up of 1.9 years (interquartile range 0.9-2.0), late HAVB was documented in 30 patients. The risk of major heart failure events (hazard ratio [HR] 4.08 [1.38-12.09], P = .01) and major ventricular tachyarrhythmic events (HR = 5.41 [1.88-15.58], P = .002) were significantly increased in patients who developed late HAVB. CONCLUSION High-degree atrioventricular block documented by continuous ECG monitoring occurring more than 3 weeks after AMI is a frequent complication in post-AMI patients with left ventricular dysfunction. Furthermore, HAVB is associated with ominous prognostic implications of both potentially lethal arrhythmias and heart failure.
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Abstract
Symptomatic sustained cardiac arrhythmias are frequently observed in in the coronary care unit and often lead to hemodynamic compromise, especially in the presence of multisystem disease. The predominant arrhythmias noted in intensive care units are tachyarrhythmias, particularly atrial fibrillation and flutter, and ventricular tachycardia. Bradycardias, arguably less life-threatening than tachyarrhythmias, can arise from sinus node dysfunction or atrioventricular conduction block; transient vagally-mediated bradycardias are frequently encountered as well. Prompt diagnosis of the patient with tachycardia is critical as treatment depends on the accurate diagnosis of tachycardia mechanism. The electrocardiogram remains the most important diagnostic tool for the evaluation of both wide and narrow complex tachycardia. The electrocardiographic diagnosis of wide complex tachycardia is based on evaluation of atrioventricular relationship and QRS morphology while the diagnosis of narrow complex tachycardia is based on the location and morphology of P waves. It is important for critical care specialists to understand the principles of cardiac arrhythmia diagnosis and remain current with the recent advances in the pharmacologic and non-pharmacologic management of patients with arrhythmias.
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Affiliation(s)
- Nitish Badhwar
- Section of Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco, CA 94143, USA.
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19
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Gang UJO, Jons C, Jorgensen RM, Abildstrom SZ, Messier MD, Haarbo J, Huikuri HV, Thomsen PEB, Raatikainen MJP, Hartikainen J, Virtanen V, Boland J, Anttonen O, Hoest N, Boersma LVA, Platou ES, Becker D, Schrijver G, Robbe H, Mahaux V, Christiansen LK, Huikuri P, Karjalainen P. Risk markers of late high-degree atrioventricular block in patients with left ventricular dysfunction after an acute myocardial infarction: a CARISMA substudy. Europace 2011; 13:1471-7. [DOI: 10.1093/europace/eur165] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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20
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Hreybe H, Saba S. Location of acute myocardial infarction and associated arrhythmias and outcome. Clin Cardiol 2010; 32:274-7. [PMID: 19452487 DOI: 10.1002/clc.20357] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Cardiac arrhythmias and conduction abnormalities complicating acute myocardial infarction (AMI) have been associated with adverse prognosis in numerous reports. Small studies have frequently associated different arrhythmias with various distributions of myocardial infarctions. We analyzed a nationally representative hospital discharge database to evaluate the relationship between the location of AMI and the associated arrhythmias and conduction abnormalities and their impact on in-hospital mortality. METHODS We searched the National Hospital Discharge Survey database for patients with a diagnosis of AMI and collected data on the associated arrhythmias and conduction abnormalities. In-hospital death was used as end point for analysis. RESULTS A total of 21,807 patients, representing 2,632,217 hospital discharges in the United States, with a primary diagnosis of AMI from 1996 to 2003 were included in this analysis. Patients with inferior or posterior AMI were more likely to develop complete heart block compared to those with anterior or lateral AMI (3.7% vs 1.0%, hazard ratio [HR] = 3.9, p <or= 0.001), but less likely to die prior to hospital discharge (7.7% vs 11.3%, HR = 0.65, p <or= 0.001). CONCLUSIONS Patients with an inferior or posterior AMI are more likely to develop conduction system abnormalities when compared to patients with an anterior or lateral AMI. On the other hand, anterior or lateral MI is a significant predictor of in-hospital death.
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Affiliation(s)
- Haitham Hreybe
- Cardiology Department of the Medical College of Georgia, Augusta, Georgia, USA
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21
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Jim MH, Chan AOO, Tse HF, Barold SS, Lau CP. Clinical and Angiographic Findings of Complete Atrioventricular Block in Acute Inferior Myocardial Infarction. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2010. [DOI: 10.47102/annals-acadmedsg.v39n3p185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction: The angiographic findings and prognosis of patients with complete atrioventricular block (AVB) complicating acute inferior myocardial infarction (MI) remain unclear. Materials and Methods: The clinical and angiographic findings of 70 consecutive patients with complete AVB were compared with those of 319 patients with inferior MI without AVB (control group) admitted within the same study period. Results: Patients with complete AVB were older (68 ± 12 vs 63 ± 13 years; P = 0.004) and clustered with clinical features indicative of larger infarct size, such as right ventricular infarction, cardiogenic shock, or low left ventricular ejection fraction (LVEF). The onset of the complete AVB was observed within 24 hours in 62 (88.6%), preceded by second-degree AVB in 26 (37.1%) and the escape QRS complex was wide in 8 (11.4%) patients. In patients with complete AVB, a dominant right coronary artery occlusion was found in >95% of cases and in-hospital mortality was increased (27.1% vs 10.7%; P = 0.000), especially in those with widen QRS escape rhythm (75.0%). Reperfusion therapy had a positive impact on the natural course of complete AVB. Conclusions: Complete AVB in acute inferior MI was associated with advanced age and larger infarct size. Complete AVB was virtually always caused by dominant right coronary artery occlusion. The in-hospital mortality was significantly higher, but improved by reperfusion therapy. No permanent pacemaker is performed at a mean follow-up of 47 months.
Key words: Coronary angiography, In-hospital mortality
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Affiliation(s)
- Man-Hong Jim
- Grantham Hospital, Hong Kong, University of Hong Kong
| | - Annie OO Chan
- Queen Mary Hospital, Hong Kong, University of Hong Kong
| | - Hung-Fat Tse
- Queen Mary Hospital, Hong Kong, University of Hong Kong
| | - Serge S Barold
- Tampa General Hospital, University of South Florida College of Medicine, USA
| | - Chu-Pak Lau
- Queen Mary Hospital, Hong Kong, University of Hong Kong
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22
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Nguyen HL, Lessard D, Spencer FA, Yarzebski J, Zevallos JC, Gore JM, Goldberg RJ. Thirty-year trends (1975-2005) in the magnitude and hospital death rates associated with complete heart block in patients with acute myocardial infarction: a population-based perspective. Am Heart J 2008; 156:227-33. [PMID: 18657650 DOI: 10.1016/j.ahj.2008.03.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Accepted: 03/07/2008] [Indexed: 11/16/2022]
Abstract
BACKGROUND The contemporary magnitude and prognostic implications of complete heart block (CHB) in patients with acute myocardial infarction (AMI) are unknown. As part of a community-based study of patients hospitalized with AMI in the Worcester, MA, metropolitan area, changes over time in the incidence rates of CHB complicating AMI and the prognostic impact of CHB on short-term survival were examined. METHODS The study population consisted of 13,663 residents of the Worcester metropolitan area who were hospitalized with AMI at all greater Worcester medical centers during 15 annual periods between 1975 and 2005. RESULTS The average age of the hospitalized study sample was 69 years, and 58% were men. The overall proportion of patients with AMI who developed CHB was 4.1%. The incidence rates of CHB complicating AMI declined appreciably over time, with the greatest decline in these incidence rates occurring during the most recent years under study. In 2005, 2.0% of patients hospitalized with AMI developed CHB compared to 5.1% in the initial study year of 1975. Patients with AMI who developed CHB had higher inhospital death rates (43.2%) than did those who did not develop CHB (13.0%) (P < .001). The hospital death rates associated with CHB declined appreciably over time, particularly during the most recent years under study. Several patient characteristics were associated with an increased risk for developing CHB during hospitalization for myocardial infarcation. CONCLUSIONS Our findings indicate recent encouraging declines in the incidence rates of CHB complicating AMI and improving trends in the hospital prognosis of these patients.
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Affiliation(s)
- Hoa L Nguyen
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA
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Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Smith SC, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Faxon DP, Halperin JL, Hiratzka LF, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura RA, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol 2008; 51:e1-62. [PMID: 18498951 DOI: 10.1016/j.jacc.2008.02.032] [Citation(s) in RCA: 1101] [Impact Index Per Article: 68.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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ACC/AHA/HRS 2008 Guidelines for device-based therapy of cardiac rhythm abnormalities. Heart Rhythm 2008; 5:e1-62. [PMID: 18534360 DOI: 10.1016/j.hrthm.2008.04.014] [Citation(s) in RCA: 196] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Indexed: 01/27/2023]
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25
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Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Smith SC, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Faxon DP, Halperin JL, Hiratzka LF, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura RA, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation 2008; 117:e350-408. [PMID: 18483207 DOI: 10.1161/circualtionaha.108.189742] [Citation(s) in RCA: 935] [Impact Index Per Article: 58.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Cardiac arrhythmias routinely manifest during or following an acute coronary syndrome (ACS). Although the incidence of arrhythmia is directly related to the type of ACS the patient is experiencing, the clinician needs to be cautious with all patients in these categories. As an example, nearly 90% of patients who experience acute myocardial infarction (AMI) develop some cardiac rhythm abnormality and 25% have a cardiac conduction disturbance within 24 hours of infarct onset. In this patient population, the incidence of serious arrhythmias, such as ventricular fibrillation (4.5%) ,is greatest in the first hour of an AMI and declines rapidly thereafter. This article addresses the identification and treatment of arrhythmias and conduction disturbances that complicate the course of patients who have ACS, particularly AMI and thrombolysis. Emphasis is placed on mechanisms and therapeutic strategies.
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Affiliation(s)
- Andrew D Perron
- Department of Emergency Medicine, Maine Medical Center, Portland, 04102, USA.
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Goldstein JA, Lee DT, Pica MC, Dixon SR, O'Neill WW. Patterns of coronary compromise leading to bradyarrhythmias and hypotension in inferior myocardial infarction. Coron Artery Dis 2005; 16:265-74. [PMID: 16000883 DOI: 10.1097/00019501-200508000-00002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Occlusion and reperfusion of the acutely occluded right coronary artery may result in abrupt bradycardia and hypotension, attributed to Bezold-Jarisch cardio-inhibitory reflexes arising from the ischemic left ventricle. Given that right ventricular infarction, a result of proximal right coronary artery occlusion, predisposes to bradycardia and hypotension, we hypothesized that proximal right coronary occlusions would be more likely to result in bradycardia-hypotension compared to more distal occlusions. METHODS In 216 patients with acute inferior myocardial infarction undergoing primary angioplasty of the right coronary artery, we retrospectively analyzed the incidence of bradyarrhythmias and hypotension during occlusion and with reperfusion. RESULTS Occlusion proximal to the right ventricular branches was identified in 151 (70%) of cases, with occlusions distal but compromising the left ventricular and atrioventricular nodal branches in 65 (30%) others. During occlusion, those with proximal occlusions were more likely to suffer hypotension (41 versus 15%, P=0.0002), advanced atrioventricular block (21 versus 3%, P=0.0008) and hypotension with bradycardia (25 versus 9%, P=0.01). Similarly, reperfusion of proximal occlusions more frequently resulted in abrupt hypotension (42 versus 19%, P=0.002), bradycardia (34 versus 14%, P=0.004) and hypotension with bradycardia (27 versus 12%, P=0.02). CONCLUSIONS These data demonstrate that during right coronary artery occlusion and with reperfusion, bradycardia and hypotension develop more commonly in patients with proximal occlusions compared with those with distal occlusions. These findings suggest that reflexes arising from the ischemic right ventricle may play a role in bradyarrhythmias and hypotension.
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Affiliation(s)
- James A Goldstein
- Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
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Meine TJ, Al-Khatib SM, Alexander JH, Granger CB, White HD, Kilaru R, Williams K, Ohman EM, Topol E, Califf RM. Incidence, predictors, and outcomes of high-degree atrioventricular block complicating acute myocardial infarction treated with thrombolytic therapy. Am Heart J 2005; 149:670-4. [PMID: 15990751 DOI: 10.1016/j.ahj.2004.07.035] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In the fibrinolytic era, several studies have suggested that the rate of atrioventricular block (AVB) in the setting of acute myocardial infarction (MI) is high and is associated with increased short-term mortality. We sought to delineate predictors of AVB and determine long-term mortality of patients developing AVB in the setting of ST-segment elevation MI (STEMI) treated with thrombolytic therapy. METHODS We combined data on patients from 4 similar studies of STEMI. We identified independent predictors of AVB and compared the 6-month and 1-year mortality rates of patients with AVB (5251) to the rates of patients without AVB (70 742). RESULTS The incidence of AVB was 6.9%. Significant independent predictors of AVB included inferior MI, older age, worse Killip class at presentation, female sex, enrollment in the United States, current smoking, hypertension, and diabetes. Adjusted mortality was significantly higher in patients with AVB than in patients without AVB within 30 days (OR 3.2, 95% CI 2.7-3.7), 6 months (OR 1.6, 95% CI 1.5-1.8), and 1 year (OR 1.5, 95% CI 1.3-1.6). For patients with AVB and inferior MI, mortality odds ratios (ORs) were 2.2 (95% CI 1.7-2.7), 2.6 (95% CI 2.4-2.9), and 2.4 (95% CI 2.2-2.6) within 30 days, 6 months, and 1 year, respectively. For patients with AVB and anterior MI, mortality ORs were 3.0 (95% CI 2.2-4.1), 3.5 (95% CI 3.1-3.8), and 3.3 (95% CI 3.0-3.7) within 30 days, 6 months, and 1 year, respectively. CONCLUSIONS In the thrombolytic era, AVB in the setting of STEMI is common and associated with higher mortality. Future studies should focus on determining therapies that are effective at reducing mortality rates in such patients.
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Affiliation(s)
- Trip J Meine
- Division of Cardiology, Department of Medicine, Duke University, Durham, NC 27715, USA.
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García García C, Curós Abadal A, Serra Flores J, Tizón Marcos H, Carol Ruiz A, Valle Tudela V. Duración del bloqueo auriculoventricular completo en el infarto inferior tratado con fibrinólisis. Rev Esp Cardiol (Engl Ed) 2005. [DOI: 10.1157/13070504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Aplin M, Engstrøm T, Vejlstrup NG, Clemmensen P, Torp-Pedersen C, Køber L. Prognostic importance of complete atrioventricular block complicating acute myocardial infarction. Am J Cardiol 2003; 92:853-6. [PMID: 14516893 DOI: 10.1016/s0002-9149(03)00900-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Third-degree atrioventricular block after acute myocardial infarction is considered to have prognostic importance. However, its importance in conjunction with thrombolytic therapy and its relation to left ventricular function remains uncertain. This report also outlines an important distinction between atrioventricular block in the setting of anterior and inferior wall acute myocardial infarction, with profound clinical and prognostic implications.
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Affiliation(s)
- Mark Aplin
- Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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32
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Ben Ameur Y, Mghaieth F, Ouchallal K, Hmem M, Terras M, Longo S, Bouraoui L, Kraïem S, Slimane ML. [Prognostic significance of second and third degree atrioventricular block in acute inferior wall myocardial infarction]. Ann Cardiol Angeiol (Paris) 2003; 52:30-3. [PMID: 12710292 DOI: 10.1016/s0003-3928(02)00123-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
High degree atrioventricular block complicates inferior wall acute myocardial infarction in 10 to 15% of cases. Its significance is still controversial. In this study, we have analysed 152 observations of acute inferior wall myocardial infarction during hospitalisation period. The mean age of our patients is 60 years, 48.7% of them have received fibrinolytic treatment. Second or third degree atrioventricular block was detected in 33 cases (21.7%). Mortality is higher in inferior wall myocardial infarctions with atrioventricular block than in those without atrioventricular block (12% versus 2.5%, p < 0.05). Hemodynamic complications like cardiogenic shock due to the extension of the infarction to the right ventricle and left ventricle insufficiency are more frequent (18% versus 3.4%, p < 0.01 and 12% versus 3.5%, p < 0.01 respectively). It appears that the infracted mass of myocardium is larger in case of atrioventricular block, this is assessed by comparing the average value of the peak of creatine Kinase in the two groups with and without atrioventricular block (1534 IU versus 1096 IU, p < 0.02) and by considering the rate of low ejection fraction (EF < 40%) in each group (44.6% versus 16%, p < 0.01). In our study, we note that thrombolysis does not affect the incidence of atrioventricular block (19% and 24% in thrombolyed and not thrombolyzed patients respectively) but it seems that thrombolysis improves the outcome of these patients. The occurrence of atrioventricular block in acute inferior wall myocardial infarction is related to the presence of an important right coronary artery that is occluded, the recanalisation of this vessel leads often to rapid regression of the block that is no longer pejorative.
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Affiliation(s)
- Y Ben Ameur
- Service de cardiologie, hôpital Habib-Thameur, Montfleury CP 1008, Tunisie
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Fang J, Alderman MH. Dissociation of hospitalization and mortality trends for myocardial infarction in the United States from 1988 to 1997. Am J Med 2002; 113:208-14. [PMID: 12208379 DOI: 10.1016/s0002-9343(02)01172-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE Although age-adjusted mortality from myocardial infarction in the United States has declined during the past few decades, changes in the incidence of myocardial infarction are less certain. To address this issue, we evaluated trends in hospitalization for, and in-hospital mortality from, myocardial infarction from 1988 to 1997. METHODS Hospitalization rates were determined by age and sex using data from the National Hospital Discharge Survey and the Current Population Survey. Comorbid conditions, complications, use of cardiac procedures, and in-hospital mortality were measured. In-hospital mortality was estimated after adjusting for associated risk factors, complications, use of invasive diagnostic and therapeutic procedures, and length of stay. RESULTS Age-adjusted rates of hospitalization for myocardial infarction were 525 per 100,000 in 1988 and 482 per 100,000 in 1997, with a mean annual decline of 0.8% (P = 0.32). Mortality declined from 58 per 100,000 in 1988 to 40 per 100,000 in 1997, a mean annual decline of 4.2% (P = 0.01). During these 10 years, although the median hospital stay for myocardial infarction decreased from 8 to 5 days, the intensity of hospital care increased, including use of angiography from 20% to 31% (P = 0.04) and revascularization from 16% to 31% (P = 0.004). Age-adjusted in-hospital mortality decreased by nearly half, from 7.6% in 1988 to 3.9% in 1997 (P = 0.006). CONCLUSION During the past decade, the decline in mortality from myocardial infarction in the United States has not been accompanied by a decline in hospitalization rate. At the same time, there has been a marked increased in the use of cardiac revascularization.
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Affiliation(s)
- Jing Fang
- Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, New York 10461, USA.
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Melgarejo Moreno A, Galcerá Tomás J, García Alberola A, Gil Sánchez J, Martínez Hernández J, Rodríguez Fernández S, Ortín Katnich L, Murcia Payá JF. [Prognostic significance of the implantation of a temporary pacemaker in patients with acute myocardial infarction]. Rev Esp Cardiol 2001; 54:949-57. [PMID: 11481109 DOI: 10.1016/s0300-8932(01)76430-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Indication of temporary pacemakers in patients during acute myocardial infarction was widely studied in the pre-thrombolytic era without having determined whether the generalization of fibrinolysis might have changed the overall incidence and significance of temporary pacemakers. Our aim was to determine the incidence and the prognostic significance of insertion of temporary pacemakers in patients with acute myocardial infarction. PATIENTS AND METHODS In a study involving 1,239 patients consecutively admitted to hospital with acute myocardial infarction we studied clinical characteristics and prognosis depending on temporary pacemaker insertion or not. We performed an univariate analysis on in-hospital mortality and those selected variables were introduced in to a logistic regression analysis. RESULTS A temporary pacemaker was indicated in 55 patients (4.4%), prophylactically in 22% and therapeutically in 78%. Temporary pacemakers were inserted in 55% of the patients with advanced AV block and in the 10% of the patients with bundle-branch block. Pacemaker insertion was associated with higher number of affected leads in the ECG, and higher CK peak, regardless of the association with thrombolysis. The following complications were more often observed in patients with temporary pacemakers: atrial fibrillation, heart failure, right bundle-branch block, advanced atrioventricular block and in-hospital mortality (45.4 vs 10.2%; p < 0.001). Need for a temporary pacemaker was less frequent in patients treated with thrombolytics compared with those not treated (3.0 vs 6.1%; p < 0.02). Pacemaker insertion had an independent value for predicting in-hospital mortality (OR = 5.51; 95% CI, 2.71-11.19). CONCLUSION The insertion of a temporary pacemaker in acute myocardial infarction is less frequent nowadays than on the pre-thrombolytic era. Pacemaker insertion is associated with higher indices of infarct extension and in-hospital mortality, having independent prognostic value on the in-hospital mortality.
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Affiliation(s)
- A Melgarejo Moreno
- Servicio de Medicina Intensiva, Unidad Coronaria, Hospital Santa María del Rosell, Cartagena
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Rathore SS, Gersh BJ, Berger PB, Weinfurt KP, Oetgen WJ, Schulman KA, Solomon AJ. Acute myocardial infarction complicated by heart block in the elderly: prevalence and outcomes. Am Heart J 2001; 141:47-54. [PMID: 11136486 DOI: 10.1067/mhj.2001.111259] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although second- and third-degree heart block (HB) are common conduction disorders associated with acute myocardial infarction (MI), patient characteristics and HBs association with outcomes, particularly among the elderly, remain poorly defined. METHODS We evaluated 106,780 Medicare beneficiaries aged 65 years and older treated for acute MI between January 1994 and February 1996 for development of HB. HB and non-HB patients were compared by univariate analysis, and the influence of HB on outcomes was evaluated by unadjusted and multiple logistic regression. RESULTS HB was documented in 5048 (4.7%) patients; 1646 presented with HB and 3402 developed HB during hospitalization. HB was more common among patients with inferior infarctions than anterior infarctions (7.3% vs 3.0%, P =.001), particularly the cohort of patients with inferior MI treated with reperfusion therapy (8.3%). HB patients had higher rates of in-hospital mortality (29.6% vs. 17.5% vs. non-HB patients, P =.001). After adjustment for demographic and clinical factors, HB remained an independent predictor of in-hospital mortality (relative risk [RR] 1.41, 95% confidence interval [CI] 1. 34-1.48), but HB had no prognostic significance at 1 year among hospital survivors (RR 0.94, 95% CI 0.88-1.01). Mortality risks varied on the basis of MI location. Both anterior MI (RR 1.46, 95% CI 1.30-1.63) and inferior MI (RR 1.52, 95% CI 1.39-1.66) patients with HB had increased risks of in-hospital mortality. There was a trend toward increased mortality among patients with anterior MI (RR 1.15, 95% CI 0.99-1.32) at 1 year, whereas those with inferior MI were at lower risk (RR 0.83, 95% CI 0.75-0.98). CONCLUSIONS HB is a common complication of acute MI in elderly patients, particularly among patients with inferior MIs who received reperfusion therapy. HB is independently associated with short-term but not long-term mortality.
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Affiliation(s)
- S S Rathore
- Division of Cardiology, Department of Medicine, Georgetown University Medical Center, Washington, DC 20007, USA
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36
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Affiliation(s)
- G S Reeder
- Mayo Medical School, Rochester, Minn., USA
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37
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Melgarejo Moreno A, Galcerá Tomás J, García Alberola A, Martínez Hernández J, Rodríguez Mulero MD. [Prognostic significance of advanced atrioventricular block in patients with acute myocardial infarction]. Med Clin (Barc) 2000; 114:321-5. [PMID: 10786330 DOI: 10.1016/s0025-7753(00)71282-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Advanced atrioventricular block (AB) during acute myocardial infarction (AMI), characterizes a high-risk subgroup of patients. Our aim was to determine the prognostic significance of AB and its possible peculiarities in relation to infarction localization and/or the thrombolytic therapy. PATIENTS AND METHODS The prospective study involved 1,239 patients with AMI. We studied clinical characteristics, as well as indexes of infarct size, short and long-term complications. RESULTS AB was present in 85 (6.8%) patients and was more often associated with: previous treatment with diuretics, diabetes, inferior localisation, higher number of ECG leads with elevated ST segment, and higher peak of CK. The AB was associated with a higher mortality: in-hospital (27% vs 10.6%; p < 0.01)) and after one-year (31.7% vs 19.4%; p < 0.05). Patients with AB had a different in-hospital mortality depending on anterior or inferior infarct localization (66% vs 18.5%; p < 0.001, respectively). In patients receiving thrombolytic treatment (n = 681), the duration of AB was shorter and in-hospital mortality was lower (13.7% vs 47%, p < 0.11) than that occurred in patients without this treatment (n = 558). AB had independent value for predicting in-hospital mortality (OR: 3.56; 95% CI: 1.84-6.90) and one-year mortality (OR: 2.77; 95% CI: 1.52-5.04). CONCLUSIONS AB is associated with larger infarcts and higher incidence of complications. The prognosis is especially poor when it is presented associated with anterior infarction and/or in patients without thrombolytic treatment. AB is a variable with independent prognostic value on the mortality.
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Affiliation(s)
- A Melgarejo Moreno
- Servicio de Medicina Intensiva, Hospital Santa María del Rosell de Cartagena
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El electrocardiograma en la estimación inicial del pronóstico de pacientes con infarto agudo de miocardio. Med Intensiva 2000. [DOI: 10.1016/s0210-5691(00)79586-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Harpaz D, Behar S, Gottlieb S, Boyko V, Kishon Y, Eldar M. Complete atrioventricular block complicating acute myocardial infarction in the thrombolytic era. SPRINT Study Group and the Israeli Thrombolytic Survey Group. Secondary Prevention Reinfarction Israeli Nifedipine Trial. J Am Coll Cardiol 1999; 34:1721-8. [PMID: 10577562 DOI: 10.1016/s0735-1097(99)00431-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We assessed the incidence, associated clinical parameters and prognostic significance of complete atrioventricular block (CAVB) complicating acute myocardial infarction (AMI) in the thrombolytic era and compared them to data from the prethrombolytic era. BACKGROUND The introduction of new therapeutic modalities to treat AMI, aimed to enhance coronary reperfusion and to limit myocardial necrosis, was expected to decrease the incidence of CAVB and to improve prognosis. However, there are only limited data regarding the incidence and the prognosis of AMI patients with CAVB in the thrombolytic era. METHODS Data from 3,300 patients from the Israeli Thrombolytic Surveys (prospective, nationwide surveys of consecutive patients with AMI in all 25 coronary-care units in Israel in 1992 and 1996) were analyzed and compared with data from 5,788 patients included in the SPRINT (Secondary Prevention Reinfarction Israeli Nifedipine Trial) Registry (1981 to 1983). RESULTS During the 1990s, the incidence of CAVB was 3.7% compared with 5.3% in the 1980s, p = 0.0007. In the 1990s, mortality of patients with CAVB was significantly higher than in those without CAVB at 7 days (odds ratio [OR] = 4.05 95% CI [confidence interval] 2.34 to 6.82, 30 days OR = 3.98 [95% CI 2.44 to 6.43] and one-year hazard ratio [HR] = 2.36, [95% CI 1.68 to 3.30]) and similar in thrombolysis-treated and not-treated patients. Mortality of patients with CAVB has not changed significantly between the two periods; seven-day OR = 0.82 (95% CI 0.46 to 1.43); 30-day OR = 0.78 (95% CI 0.45 to 1.33) and one-year HR = 0.79 (95% CI 0.54 to 1.56), respectively, in the 1990s as compared to a decade earlier. CONCLUSIONS The incidence of CAVB complicating AMI is lower in the thrombolytic era than in the prethrombolytic era. Mortality among patients with CAVB is still high and has not declined within the last decade. The AMI patients who develop CAVB in the thrombolytic era have significantly worse prognosis than do patients without CAVB.
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Affiliation(s)
- D Harpaz
- Heart Institute, E. Wolfson Medical Center, Holon, Israel.
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40
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Kimura K, Kosuge M, Ishikawa T, Shimizu M, Hongo Y, Sugiyama M, Tochikubo O, Umemura S. Comparison of results of early reperfusion in patients with inferior wall acute myocardial infarction with and without complete atrioventricular block. Am J Cardiol 1999; 84:731-3, A8. [PMID: 10498146 DOI: 10.1016/s0002-9149(99)00422-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We investigated the effect of reperfusion in patients with complete atrioventricular block within 6 hours after the onset of inferior wall acute myocardial infarction. Early reperfusion may promote the restoration of normal sinus rhythm and effectively reduce infarct size in these patients.
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Affiliation(s)
- K Kimura
- Critical Care and Emergency Medical Center, Yokohama City University School of Medicine, Japan.
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41
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Simons GR, Sgarbossa E, Wagner G, Califf RM, Topol EJ, Natale A. Atrioventricular and intraventricular conduction disorders in acute myocardial infarction: a reappraisal in the thrombolytic era. Pacing Clin Electrophysiol 1998; 21:2651-63. [PMID: 9894656 DOI: 10.1111/j.1540-8159.1998.tb00042.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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42
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Aufderheide TP. Arrhythmias associated with acute myocardial infarction and thrombolysis. Emerg Med Clin North Am 1998; 16:583-600, viii. [PMID: 9739776 DOI: 10.1016/s0733-8627(05)70019-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Ninety percent of patients with acute myocardial infarction have some cardiac rhythm abnormality, and approximately twenty-five percent have cardiac conduction disturbance within 24 hours following infarct onset. Almost any rhythm disturbance can be associated with acute myocardial infarction, including bradyarrhythmias, supraventricular tachyarrhythmias, ventricular arrhythmias, and atrioventricular block. With the advent of thrombolytic therapy, it was found that some rhythm disturbances in patients with acute myocardial infarction may be related to successful coronary artery reperfusion. This article addresses the role and treatment of arrhythmias and conduction disturbances that complicate the course of patients with acute infarction and thrombolysis.
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Affiliation(s)
- T P Aufderheide
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, USA
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43
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Matetzky S, Freimark D, Chouraqui P, Rabinowitz B, Rath S, Kaplinsky E, Hod H. Significance of ST segment elevations in posterior chest leads (V7 to V9) in patients with acute inferior myocardial infarction: application for thrombolytic therapy. J Am Coll Cardiol 1998; 31:506-11. [PMID: 9502627 DOI: 10.1016/s0735-1097(97)00538-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This study was designed to examine whether ST segment elevation in posterior chest leads (V7 to V9) during acute inferior myocardial infarction (MI) identifies patients with a concomitant posterior infarction and whether these patients might benefit more from thrombolysis. BACKGROUND Because the posterior wall is faced by none of the 12 standard electrocardiographic (ECG) leads, the ECG diagnosis of posterior infarction is problematic and has often remained undiagnosed, especially in the acute phase. METHODS Eighty-seven patients with a first inferior infarction who were treated with recombinant tissue-type plasminogen activator were stratified according to the presence (Group A [46 patients]) or absence (Group B [41 patients]) of concomitant ST segment elevation in posterior chest leads V7 to V9. RESULTS Patients in Group A had a higher incidence of posterolateral wall motion abnormalities (p < 0.001) on radionuclide ventriculography, a larger infarct area (as evidenced by higher peak creatine kinase levels) (p < 0.02) and a lower left ventricular ejection fraction (LVEF) at hospital discharge (p < 0.008) than those in Group B. ST segment elevation in leads V7 to V9 was associated with a higher incidence of at least one of the following adverse clinical events: reinfarction, heart failure or death (p = 0.05). Although patency of the infarct-related artery (IRA) in Group A resulted in an improved LVEF at discharge (p < 0.012), LVEF was unchanged in Group B, regardless of the patency status of the IRA. CONCLUSIONS ST segment elevation in leads V7 to V9 identifies patients with a larger inferior MI because of concomitant posterolateral involvement. Such patients might benefit more from thrombolytic therapy.
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Affiliation(s)
- S Matetzky
- Heart Institute, Sheba Medical Center, Tel-Hashomer, Israel
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Birnbaum Y, Sclarovsky S, Herz I, Zlotikamien B, Chetrit A, Olmer L, Barbash GI. Admission clinical and electrocardiographic characteristics predicting in-hospital development of high-degree atrioventricular block in inferior wall acute myocardial infarction. Am J Cardiol 1997; 80:1134-8. [PMID: 9359538 DOI: 10.1016/s0002-9149(97)00628-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study assessed the ability of simple clinical and electrocardiographic variables routinely obtained on admission to identify patients who are at high risk of developing high-degree atrioventricular (AV) block during hospitalization in 1,336 patients with inferior wall acute myocardial infarction (AMI). Patients were classified into 2 initial electrocardiographic patterns based on the J-point to R-wave amplitude ratio: pattern 1: those with J point/R wave <0.5 and pattern 2: patients with J point/R wave > or =0.5 in > or =2 leads of the inferior leads II, III, and aVF. High-degree AV block was found in 6.7% of patients (41 of 615) with pattern 1 versus 11.8% of the patients (85 of 721) with pattern 2 on admission electrocardiogram (p = 0.0008). Multivariate logistic regression analysis revealed that the only variables found to be independently associated with high-degree AV block were female gender (odds ratio [OR] 1.48; 95% confidence interval [CI] 0.98 to 2.23; p = 0.06); Killip class on admission > or =2 (OR 2.24; CI 1.43 to 3.51; p = 0.0004); initial electrocardiographic pattern 2 versus pattern 1 (OR 1.82; CI 1.22 to 2.21; p = 0.003); and absence of abnormal Q waves on admission (OR yes vs no 0.68; CI 0.44 to 1.05; p = 0.08). A simple electrocardiographic sign (J point/R wave > or =0.5 in > or =2 leads) is a reliable predictor of the development of advanced AV block among patients receiving thrombolytic therapy for inferior wall AMI.
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Affiliation(s)
- Y Birnbaum
- Beilinson Medical Center, Petah-Tiqva, Israel
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45
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Barold SS. American College of Cardiology/American Heart Association guidelines for pacemaker implantation after acute myocardial infarction. What is persistent advanced block at the atrioventricular node? Am J Cardiol 1997; 80:770-4. [PMID: 9315587 DOI: 10.1016/s0002-9149(97)00513-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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46
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Abstract
Several clinical factors can influence the pathophysiology, clinical course and prognosis of acute myocardial by different means. Some of them may be easily detected through the history, physical examination or ECG in an early phase. The knowledge of these factors may help the therapeutic decision making of patients with myocardial infarction. The influence for the main clinical factors (age, sex, risk factors, cardiologic antecedents and evolutive findings) on the short-term prognosis of acute myocardial infarction is reviewed. An analysis of the likely mechanisms of the influence of these factors on infarct prognosis is also performed.
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Affiliation(s)
- H Bueno
- Departamento de Cardiología, Hospital Universitario General Gregorio Marañón, Madrid
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47
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Abstract
Although thrombolytic therapy for acute myocardial infarction (MI) is recommended without regard for infarct location, treatment results are less impressive for inferior than for anterior MI because the amount of myocardium at risk is smaller and less strategically located, and the mortality risk is lower. Whereas the risks associated with anterior MI are relatively constant, high risk subsets of patients with an inferior MI can be identified by simple electrocardiographic criteria, including left precordial ST segment depression, complete atrioventricular heart block and right precordial ST segment elevation. Unfortunately, none of the placebo-controlled, randomized trials have analyzed the benefit of thrombolytic therapy for inferior MI in high risk versus low risk subsets. Thrombolytic therapy should be more successful in reducing infarct size and decreasing mortality in high risk patients with an inferior MI. Thrombolytic therapy may not decrease hospital mortality in low risk patients (baseline risk 2% to 4%) or those with symptom duration > 6 h. Whereas it is arguable whether coronary angioplasty is superior to thrombolytic therapy in anterior MI, there are no mortality data to support using angioplasty as a primary or rescue reperfusion strategy instead of thrombolytic therapy in inferior MI, unless thrombolytic contraindications are present or the patient is in cardiogenic shock.
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Affiliation(s)
- E R Bates
- Department of Internal Medicine, University of Michigan, Ann Arbor, USA
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48
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Haim M, Hod H, Kaplinsky E, Reicher-Reiss H, Barzilay J, Boyko V, Goldbourt U, Behar S. Frequency and prognostic significance of high-degree atrioventricular block in patients with a first non-Q-wave acute myocardial infarction. The SPRINT Study Group. Second Prevention Reinfarction Israeli Nifedipine Trial. Am J Cardiol 1997; 79:674-6. [PMID: 9068532 DOI: 10.1016/s0002-9149(96)00839-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Patients with a first non-Q-wave acute myocardial infarction with high-degree atrioventricular block were compared with patients without atrioventricular block. In-hospital complications and mortality were significantly higher among patients with atrioventricular block; atrioventricular block emerged as an important prognostic predictor of early mortality in these patients.
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Affiliation(s)
- M Haim
- Neufeld Cardiac Research Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel
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49
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Moreno AM, Tomás JG, Alberola AG, Chávarri MV, Soria FC, Sánchez JG, García PR. Significación pronóstica del bloqueo auriculoventricular completo en pacientes con infarto agudo de miocardio inferior. Un estudio en la era trombolítica. Rev Esp Cardiol (Engl Ed) 1997. [DOI: 10.1016/s0300-8932(97)73241-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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50
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Affiliation(s)
- G S Reeder
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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