Related Experiment Video
Updated: Mar 23, 2026
Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs
Published on: April 17, 2021
Periprocedural temporary pacing in primary percutaneous coronary intervention for patients with acute inferior
You Mi Hwang1, Chul-Min Kim2, Keon-Woong Moon2
1Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Insights
Temporary pacing (TP) is not necessary for patients with acute inferior ST-elevation myocardial infarction (STEMI) and complete atrioventricular block (AVB). Primary percutaneous coronary intervention (PCI) should be prioritized to avoid reperfusion delays.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- High-degree atrioventricular block (AVB) is a known complication of acute inferior ST-elevation myocardial infarction (STEMI).
- The prognostic significance of temporary pacing (TP) in STEMI patients with complete AVB remains unclear.
Purpose of the Study:
- To investigate the clinical differences and prognostic significance of TP in patients with inferior STEMI complicated by complete AVB.
Main Methods:
- A retrospective review of 295 consecutive inferior STEMI patients who underwent primary percutaneous coronary intervention (PCI).
- Comparison of clinical characteristics, procedural data, and major adverse cardiocerebrovascular events (MACCE) between patients with and without TP (n=72).
Main Results:
- Baseline characteristics were similar between groups.
- Patients receiving TP were more likely to present with cardiogenic shock and required additional interventions.
- No significant difference in MACCE was observed between patients with and without TP after a median follow-up of 344 days.
Conclusions:
- Primary PCI without TP is an acceptable strategy for acute inferior STEMI with complete AVB.
- Prioritizing primary PCI over initial TP can help avoid delays in crucial reperfusion therapy.
Objective:
High-degree atrioventricular block (AVB), including complete AVB in acute inferior ST-elevation myocardial infarction (STEMI), is not uncommon. However, there is no study evaluating the clinical differences between patients who have undergone temporary pacing (TP) and patients who have not. The present study was designed to investigate whether TP has any prognostic significance in inferior STEMI complicated by complete AVB.
Methods:
From January 2009 to December 2014, 295 consecutive patients diagnosed with inferior wall STEMI in a university hospital were reviewed. All of them underwent primary percutaneous coronary intervention (PCI). Among the 295 patients, there were 72 patients with complete AVB. The clinical characteristics, procedural data, and long-term major adverse cardiocerebrovascular events were compared in patients with and without TP.
Results:
Baseline clinical and procedural characteristics were similar between patients with and without TP. Patients with TP were more likely to present with cardiogenic shock; thus, additional interventions were attempted via a femoral approach, as patients received further treatment with intra-aortic balloon pumps and were subjected to additional cardiopulmonary resuscitation. Most cases of complete AVB were primarily caused by right coronary artery occlusion. After a median follow-up period of 344 (range, 105.5-641) days, major adverse cardiocerebrovascular events did not differ between the groups (P=0.528).
Conclusion:
We conclude that primary PCI without TP is acceptable in complete AVB-complicated acute inferior STEMI. To avoid delay in reperfusion, we suggest that primary PCI should be the first priority therapy rather than treating patients initially with TP.
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:30Acute Coronary Syndrome I: Introduction