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2:1 and phase 4 peri-infarction block.

P Alboni, C Malacarne, A Pradella

    European Journal of Cardiology
    |September 1, 1979
    PubMed
    Summary
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    This study details a patient experiencing heart block during myocardial infarction. The block, initially 2:1 AV block with aberrant conduction, evolved to Wenckebach-type block, suggesting a peri-infarction block.

    Area of Science:

    • Cardiology
    • Electrophysiology
    • Cardiac Imaging

    Background:

    • Acute myocardial infarction can precipitate complex cardiac arrhythmias.
    • Atrioventricular (AV) block is a known complication, but its specific localization and conduction patterns require detailed investigation.

    Observation:

    • A patient presented with acute inferior and anteroseptal myocardial infarction.
    • Initial presentation included 2:1 AV block with aberrant ventricular conduction, followed by Wenckebach-type 2nd-degree AV block.
    • Intracavitary recordings indicated aberrancy was due to intraventricular block, distinct from main left bundle branch or fascicular blocks.

    Findings:

    • The patient demonstrated a phase 4 peripheral block, termed peri-infarction block, secondary to myocardial infarction.
    • Vectorcardiogram (VCG) findings localized the block to the posterior wall of the right ventricle.

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  • ECG and VCG excluded block involvement in the main bundles or left bundle fascicles.

    • Implications:

    • This case highlights a specific type of AV block associated with myocardial infarction, localized to the right ventricle's posterior wall.
    • Understanding peri-infarction block mechanisms aids in accurate diagnosis and management of complex arrhythmias post-MI.
    • VCG analysis is crucial for precise localization of intraventricular conduction abnormalities in myocardial infarction patients.