The time to reversal of complete atrioventricular block and its predictors in acute ST-segment elevation myocardial
Satyavir Yadav1, Himanshu Yadav2, Sudhanshu Kumar Dwivedi2
1Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
Insights
Complete atrioventricular block (CAVB) in ST-segment elevation myocardial infarction (STEMI) is uncommon but usually reversible. Primary percutaneous coronary intervention (PCI) significantly shortens the time to CAVB reversal compared to thrombolysis.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Complete atrioventricular block (CAVB) is a rare complication of ST-segment elevation myocardial infarction (STEMI).
- Understanding the factors influencing CAVB reversal is crucial for patient management and outcomes.
Purpose of the Study:
- To determine the time to reversal of CAVB in STEMI patients.
- To compare the effectiveness of different treatment modalities on CAVB reversal time.
- To identify factors associated with early CAVB reversal and mortality.
Main Methods:
- Prospective assessment of STEMI patients with CAVB.
- Analysis of mean time to CAVB reversal based on treatment received.
- Multivariate logistic regression to identify predictors of mortality.
Main Results:
- CAVB occurred in 3.7% of STEMI patients, predominantly with inferior wall myocardial infarction (IWMI).
- Mean CAVB reversal time was 25.4 ± 35.5 hours, significantly shorter with primary PCI (5.21 ± 10.54 hours) versus thrombolysis (12.98 ± 17.14 hours).
- Early presentation, IWMI, revascularization (especially primary PCI), and normal creatinine predicted early reversal; older age, wider QRS, shock/heart failure, and elevated creatinine predicted mortality.
Conclusions:
- CAVB is uncommon in STEMI and typically resolves in most survivors.
- Primary PCI accelerates CAVB reversal compared to thrombolysis.
- Revascularization is critical; outcomes are poor without it.
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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