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Myocardial infarction complicated by heart block--treatment and long-term prognosis

S A Forsberg, S Juul-Möller

    Acta Medica Scandinavica
    |January 1, 1979
    PubMed

    Insights

    Heart block following acute myocardial infarction (AMI) worsens prognosis but survival is independent of block degree. Conservative treatment for complete heart block showed similar survival to aggressive pacing, questioning routine artificial pacing in AMI patients.

    Area of Science:

    • Cardiology
    • Internal Medicine

    Background:

    • Acute myocardial infarction (AMI) can lead to various heart blocks.
    • Continuous electrocardiogram (ECG) monitoring is standard in coronary care units.

    Purpose of the Study:

    • To investigate the incidence and prognostic impact of heart block in AMI patients.
    • To evaluate the effectiveness of conservative versus aggressive pacing strategies for complete heart block in AMI.

    Main Methods:

    • Prospective monitoring of 597 AMI patients in a coronary care unit.
    • Classification of heart block degrees (first, second, complete).
    • Two-year survival tracing and comparison with a historical pacing group.

    Main Results:

    • 84 patients (14%) developed heart block; 39 had complete heart block.
    • Heart block was associated with a worse two-year prognosis.
    • Survival rates for complete heart block were similar between conservative treatment (including isoproterenol and temporary pacing) and a historical group receiving routine artificial pacing.

    Conclusions:

    • Heart block degree does not significantly impact two-year survival post-AMI.
    • Indiscriminate artificial pacing for complete heart block in AMI is not supported by these findings.
    • Further randomized controlled trials are warranted to confirm these results.

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