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[Use of the temporary pacemaker in acute myocardial infarct]
Insights
Temporary pacemakers in acute myocardial infarction patients showed high mortality, especially with complete AV block. However, the procedure itself had minimal complications, validating its continued use in indicated cases.
Area of Science:
- Cardiology
- Electrophysiology
Context:
- Acute myocardial infarction (AMI) patients often require temporary pacemakers.
- High mortality rates are observed in AMI patients with conduction disturbances.
Purpose:
- To analyze the mortality and complications associated with temporary pacemaker use in AMI patients.
- To evaluate the impact of specific conduction blocks on mortality.
Summary:
- This study analyzed 80 AMI patients requiring temporary pacemakers, revealing an overall mortality of 33.75%, significantly higher than the general AMI mortality (12%).
- Mortality increased substantially with complete atrioventricular (AV) block (51.35%), RBBB and first-degree AV block (80%), cardiac failure (94%), and cardiogenic shock (100%).
- Second-degree AV block patients had no mortality unless progressing to complete AV block, often associated with posterior infarction and right ventricular extension without severe heart failure. Permanent pacemaker implantation was needed in 7.5% of cases.
Impact:
- Temporary pacemaker insertion in AMI patients had no major complications, supporting the established indications for its use.
- Understanding mortality risks associated with specific conduction blocks aids in patient management and risk stratification.
- The findings reinforce the clinical utility of temporary pacemakers in managing complex AMI cases.
Abstract:
80 patients with acute myocardial infarction were analyzed in our coronary heart unit in whom the use of a transient pacemaker was indicated. The over all mortality was 33.75%, three fold the general myocardial infarction mortality in the CCU of the INCICH which is 12%, and increased to 51.35% in those with complete AV block. The mortality rate was even more significative with the association of RBBB and first degree AV block (80%). Cardiac failure was a fatal complication in 94% of that group of patients, and it increased to 100% in those with cardiogenic shock. Except those who progressed to complete AV block, there was not mortality in the patients with 2nd degree AV block. In the last mentioned group, predominated the posterior infarction with extension to the right ventricle and none had severe heart failure. The mortality rate was low in patients with recent LBBB or in those with RBBB associated to left branch hemiblock, but the majority had the disturbance permanently. In 7.5% of the patients implantation of a permanent pacemaker was necessary. In half of them due to the presence of a 3rd degree AV block of more than one moth duration. We conclude that the insertion of a temporary pacemaker in our cases had no major complications and the 12 accepted indications for this still hold on.