Right bundle-branch block and left axis deviation in acute myocardial infarction

Area of Science:

• Cardiology
• Electrophysiology

Background:

• Antero-septal myocardial infarction (MI) with right bundle-branch block (RBBB) is a critical condition.
• This specific MI subtype is associated with significant morbidity and mortality.

Purpose of the Study:

• To investigate the clinical outcomes and complications in patients with acute antero-septal MI and RBBB.
• To evaluate the effectiveness of early pacemaker intervention in mitigating mortality in this patient cohort.

Main Methods:

• Retrospective analysis of 114 consecutive acute myocardial infarction patients admitted to a coronary care unit.
• Focus on patients presenting with antero-septal MI, RBBB, and specific axis deviations.
• Documentation of complications, mortality, and the use of external on-demand pacemakers.

Main Results:

• Eleven patients had antero-septal MI with RBBB; 10 had left axis deviation, 1 had right axis deviation.
• High mortality rate (7/11 patients) observed, primarily due to cardiogenic shock.
• Sudden complete heart block and ventricular asystole were frequent complications.
• Insertion of an external on-demand pacemaker in 10 patients resulted in zero deaths from these arrhythmias.

Conclusions:

• Acute antero-septal myocardial infarction with right bundle-branch block is associated with a high risk of mortality.
• Sudden cardiac arrhythmias, including complete heart block and ventricular asystole, are significant complications.
• Prompt insertion of an external on-demand pacemaker is a life-saving intervention for these high-risk patients.