Significance of advanced atrioventricular block in acute inferior myocardial infarction--a study based on ventricular function and Holter monitoring.
Eighty-two consecutive patients with a first inferior wall acute myocardial infarction were evaluated by radionuclide angiography and 24-hour Holter monitoring during their hospital stay. The patients were divided into two groups. The first group (n = 28) had advanced atrioventricular block, while the second group (n = 54) were without atrioventricular block. The patients with advanced block had lower left ventricular (49 +/- 12% vs. 55 +/- 14%, P less than 0.05) and right ventricular ejection fraction (26 +/- 10% vs. 43 +/- 11%, P less than 0.001) than those with normal atrioventricular conduction. The atrioventricular block disappeared spontaneously in all of them. The hospital mortality of the patients with advanced block and those without advanced block was 10.7 and 5.5%, respectively (P = NS). Pre-discharge 24-hour Holter monitoring done in all survivors revealed isolated ventricular ectopics (Lown grade I, II, III) in 44% of patients who had had advanced block and 43.1% of patients without advanced block (P = NS). Complex ventricular ectopics (Lown grade IVa, IVb), however, were recorded in significantly more patients with advanced block as compared to patients without advanced block (36 vs. 7.8%, P less than 0.01). Most patients with complex ventricular ectopics in both groups had impaired left or right ventricular function.(ABSTRACT TRUNCATED AT 250 WORDS)
Kaul
U
U
Hari Haran
V
V
Malhotra
A
A
Bhatia
M L
ML
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000503:physiopathology; D001283:Atrioventricular Node / Q000503:physiopathology*; D005117:Cardiac Complexes, Premature / Q000503:physiopathology; D002302:Cardiac Output; D004562:Electrocardiography / Q000379:methods*; D006327:Heart Block / Q000503:physiopathology*; D006329:Heart Conduction System / Q000503:physiopathology*; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008875:Middle Aged; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000503:physiopathology*; D011379:Prognosis; D012008:Recurrence