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Indication of permanent pacing after acute myocardial infarction complicated by combined intraventricular block
Insights
Patients with acute myocardial infarction (AMI) and intraventricular block have high mortality. Permanent pacing improved survival rates for survivors after AMI complicated by advanced atrioventricular block.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Acute myocardial infarction (AMI) is a leading cause of mortality.
- Intraventricular block complicates AMI, significantly increasing mortality risk.
- Understanding outcomes for AMI patients with intraventricular block is crucial.
Purpose of the Study:
- To evaluate mortality and survival in patients with acute myocardial infarction (AMI) and combined intraventricular block.
- To assess the impact of permanent pacing on survival in these patients.
- To determine indications for permanent pacing in post-AMI patients with complex conduction abnormalities.
Main Methods:
- Retrospective analysis of 725 patients with AMI.
- Identification of 63 patients with combined intraventricular block.
- Comparison of survival rates between patients with and without permanent pacing.
Main Results:
- Mortality was 60.3% in patients with AMI and intraventricular block, versus 20.5% in overall AMI patients.
- Among survivors, permanent pacing was associated with a lower mortality rate (27.3%) compared to no pacing (50%).
- Sudden deaths were more frequent in patients without pacing.
Conclusions:
- Permanent pacing is indicated for patients surviving hospitalization after AMI complicated by advanced atrioventricular block.
- Patients with anterior AMI, prior myocardial infarction, and new bilateral His bundle branch block may benefit from permanent pacing.
- Early intervention with pacing can improve long-term survival in select AMI patients with conduction disturbances.
Abstract:
A total of 63 patients with combined intraventricular block with a 60.3% mortality were found among 725 patients with acute myocardial infarction (AMI) with a 20.5% mortality. 25 patients with combined intraventricular blocks survived the hospitalization period--permanent pacing having been introduced in 11 of them. The mean survival time in them was 21.7 months. There were 3 deaths (27.3%), none of them sudden. The remaining 14 patients without pacing survived for a mean period of 15.9 months, with 7 deaths (50%), four of which could be designed as sudden. The authors conclude that permanent pacing "on demand" is indicated in all patients surviving the hospitalization period after AMI complicated by advanced a-v block and after anterior AMI following an older MI with new bilateral His bundle branch block.