Relation of Heart Block and Left Ventricular Dysfunction in Acute Myocardial Infarction

doi:10.1016/S0002-9149(77)80208-7

The American Journal of Cardiology

Volume 39, Issue 7, June 1977, Pages 961-966

https://doi.org/10.1016/S0002-9149(77)80208-7 Get rights and content

Two hundred one patients with acute transmural myocardial infarction were studied to determine the relation of heart block and the degree of left ventricular dysfunction. Right bundle branch block occurred in 17, left bundle branch block in 7 and either left anterior or left posterior hemiblock in 8 patients. Hemodynamic studies were carried out before heart block developed. Complete heart block occurred in 9 of 92 patients with diaphragmatic (inferior) myocardial infarction and in 6 of 109 with anterior infarction. In patients with diaphragmatic infarction who experienced complete heart block hemodynamic measurements before block did not differ significantly from those in patients without block. Similarly, in patients who had right bundle branch block or hemiblock the hemodynamic variables did not differ from those in patients without bundle branch block.

In patients with anterior infarction who experienced complete heart block, however, stroke index (P < 0.01) and stroke work index (P < 0.05) were significantly lower before block than in patients without block. Similarly, patients with anterior infarction with progression to left bundle branch block had a lower stroke index (P < 0.002) and stroke work index (P < 0.05) than patients without bundle branch block. The data indicate that patients whose anterior infarction is followed by complete heart block or left bundle branch block have a greater degree of left ventricular dysfunction than patients with anterior infarction who do not manifest these conduction defects. The profound hemodynamic derangement in the patients with these defects is probably a result of more extensive myocardial necrosis. Complete heart block after diaphragmatic infarction and right bundle branch block and hemiblock were not associated with significantly different hemodynamic measurements, thus suggesting that these conduction defects are unrelated to the extent of left ventricular dysfunction.

Although only a small number of patients with heart block were studied, careful analysis of the clinical and hemodynamic data support the findings.

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Prognostic significance of advanced atrioventricular block in patients with acute myocardial infarction
2000, Medicina Clinica
El bloqueo auriculoventricular (BAV) avanzado en el curso del infarto agudo demiocardio caracteriza un subgrupo de pacientes con alto riesgo. Nuestro objetivo fue determinarel pronóstico del bloqueo auriculoventricular avanzado y sus peculiaridades en relación conla localización del infarto y el tratamiento trombolítico.
Estudio prospectivo sobre 1.239 pacientes con infarto agudo de miocardio.Se estudiaron las características clínicas, índices de extensión del infarto y complicaciones acorto y largo plazo.
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El BAV avanzado tuvo valor pronóstico independiente sobre la mortalidad: hospitalaria (odds ratio[OR]: 3,56; IC del 95%: 1,84–6,90) y en el primer año (OR: 2,77; IC del 95%: 1,52–5,04).
El BAV avanzado se asocia a infartos extensos y mayor incidencia de complicaciones.El pronóstico es especialmente desfavorable cuando se presenta en el infarto anteriory/o en pacientes no tratados con trombolíticos. El BAV avanzado constituye una variable independientesobre la mortalidad.
Advanced atrioventricular block (AB) during acute myocardial infarction (AMI),characterises a high-risk subgroup of patients. Our aim was to determine the prognostic significanceof AB and its possible peculiarities in relation to infarction localization and/or the thrombolytictherapy.
The prospective study involved 1,239 patients with AMI. We studied clinicalcharacteristics, as well as indexes of infarct size, short and long-term complications.
AB was present in 85 (6.8%) patients and was more often associated with: previoustreatment with diuretics, diabetes, inferior localisation, higher number of ECG leads with elevatedST 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). Patientswith 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).
AB is associated with larger infarcts and higher incidence of complications. Theprognosis is especially poor when it is presented associated with anterior infarction and/or inpatients without thrombolytic treatment. AB is a variable with independent prognostic value onthe mortality.
Spatial vectorcardiogram in acute inferior wall myocardial infarction: its utility in identification of patients prone to complete heart block
1989, International Journal of Cardiology
Spatial vectorcardiography was performed in 28 (22 males, 6 females; age 36–78 years) consecutive cases of acute inferior wall myocardial infarction during sinus rhythm within 24 hours of admission. Orthogonal leads using the corrected Frank lead system were recorded at a paper speed of 100 mm/sec. Qualitative analysis consisted of study of QRS loop inscription in all 3 orthogonal planes. Additional quantitative analysis using the spherical coordinate system was undertaken to measure the magnitude and angular direction (azimuth and elevation angle) of spatial R maximum cardiac vector. During the hospital course, 15 patients developed transient complete heart block and 13 patients did not. The direction of the QRS loop inscription in the 3 planes did not differ between the two groups. The spatial R maximum magnitude and azimuth angle did not differ between the patients who developed complete heart block and those who did not. Values for elevation angle were markedly different between the two groups. The spatial R maximum elevation angle ranged from 0 to −35° and was negative (superiorly directed) in 14 of the 15 patients with complete heart block, whereas it ranged from −10° to ± 75° and was negative (superiorly directed) in only 2 of the 13 patients without this complication. Thus it appears that negative elevation angle of spatial R maximum cardiac vector in patients with inferior wall myocardial infarction may indicate proneness to complete heart block.
Effect of age on long-term prognosis of patients with myocardial infarction
1988, International Journal of Cardiology
We studied 181 patients aged under 65 years and 129 patients over 65 with acute myocardial infarction. There were no major differences in the prevalence of coronary risk factors, angina or previous myocardial infarction. A larger percentage of elderly patients had congestive heart failure (51.4% vs 32.6%, P < 0.001) and complete heart block (17.1% vs 7.2%, P < 0.01) during the acute phase. In-hospital mortality was significantly higher in the elderly patients (34% vs 16%, P < 0.01). Late mortality rates correlated in both groups with the Killip class at the time of infarction and with the occurrence of reinfarction. In the elderly group, it was also associated with complete heart block during the acute phase. Five-year survival was 80% in the older and 72% in the younger patients (P = 0.1). Age did not affect survival of Killip class I patients (85% vs 86%, P = 0.83), but life expectancy was significantly reduced in elderly patients in Killip class greater than II (39% vs 60%, P < 0.05). In conclusion, elderly patients cannot be considered a homogeneous group of high-risk patients. Clinical variables at the time of infarction can identify low- and high-risk subsets among them. Age constitutes an independent prognostic factor for late mortality when any degree of heart failure is present.
A simplified method to predict occurrence of complete heart block during acute myocardial infarction
1986, The American Journal of Cardiology
Data were analyzed from 698 patients with proved acute myocardial infarction (AMI) to develop a method to predict the occurrence of complete heart block (CHB). The presence of electrocardiographic abnormalities of atrioventricular or intraventricular conduction during hospitalization was determined for each patient. The electrocardiographs risk factors considered were: first-degree atrioventricular block, Mobitz type I atrioventricular block, Mobitz type II atrioventricuiar block, left anterior hemiblock, left posterior hemiblock, right bundle branch block and left bundle branch block. A CHB risk score was developed that consisted of the sum of each patient's individual risk factors. CHB risk scores of 0, 1, 2 or 3 or more were associated with incidences of CHB of 1.2, 7.8, 25.0 and 36.4%, respectively. When applied to an independent AMI data base, as well as to the summed results of 6 previously reported series that identified predictors of CHB during AMI, a similar incremental risk of CHB as predicted by the risk score method was demonstrated.
Relation between QRS changes and left ventricular function after coronary artery bypass grafting
1983, The American Journal of Cardiology
Preoperative and serial postoperative electrocar-diograms (ECGs) were reviewed in 104 patients undergoing rest and exercise radionuclide angiocardiography before and 1 to 12 months after coronary artery bypass grafting (CABG). Five patient groups were defined by ECG findings before and after CABG: Group I—normal ECG before and no ECG change after CABG; Group II—prior myocardial infarction by ECG before but no QRS change after CABG; Group III—all patients with a minor QRS change (< 0.04-second Q wave, loss of R-wave amplitude) after CABG; Group IV—all patients with a major QRS change (≥ 0.04-second Q wave) after CABG; Group V—all patients without new Q waves or loss of R-wave amplitude but with a major QRS change (conduction disturbance) after CABG. Mean resting ejection fraction changed little after CABG in all groups, although the 0.03 increase in Group I was significant (p < 0.05). Group IV had the largest decrease in resting ejection fraction after CABG (0.04), but this was not statistically significant. Mean exercise ejection fraction increased significantly (p < 0.0001) in Groups I, II and III but not in Groups IV and V. QRS changes do not consistently reflect impairment of left ventricular (LV) function after CABG.
Septal ischemia as a mechanism of complete atrioventricular block: Demonstration by thallium scintigraphy
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: This study was supported in part by Contract 1 HV 81331 and Training Grant HL 05500 from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.

^*: Present address: Department of Medicine, University of Minnesota School of Medicine and Hennepin County Medical Center, Fifth and Portland South, Minneapolis, Minnesota 55415.

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Relation of Heart Block and Left Ventricular Dysfunction in Acute Myocardial Infarction

Am J Cardiol

Am Heart J

Am Heart J

Am J Cardiol

Am Heart J

J Electrocardiol

Ventricular conduction blocks and sudden death in acute myocardial Infarction. Potential indications for pacing

N Engl J Mad

The conduction system in acute myocardial infarction complicated by heart block

Circulation

Bundle branch block in acute myocardial infarction

Br Med J

Complete bundle branch block complicating acute myocardial infarction

N Engl J Med

Clinical and anatomic implications of intraventricular conduction blocks in acute myocardial infarction

Circulation