[Prognostic significance of second and third degree atrioventricular block in acute inferior wall myocardial infarction].
High degree atrioventricular block complicates inferior wall acute myocardial infarction in 10 to 15% of cases. Its significance is still controversial. In this study, we have analysed 152 observations of acute inferior wall myocardial infarction during hospitalisation period. The mean age of our patients is 60 years, 48.7% of them have received fibrinolytic treatment. Second or third degree atrioventricular block was detected in 33 cases (21.7%). Mortality is higher in inferior wall myocardial infarctions with atrioventricular block than in those without atrioventricular block (12% versus 2.5%, p < 0.05). Hemodynamic complications like cardiogenic shock due to the extension of the infarction to the right ventricle and left ventricle insufficiency are more frequent (18% versus 3.4%, p < 0.01 and 12% versus 3.5%, p < 0.01 respectively). It appears that the infracted mass of myocardium is larger in case of atrioventricular block, this is assessed by comparing the average value of the peak of creatine Kinase in the two groups with and without atrioventricular block (1534 IU versus 1096 IU, p < 0.02) and by considering the rate of low ejection fraction (EF < 40%) in each group (44.6% versus 16%, p < 0.01). In our study, we note that thrombolysis does not affect the incidence of atrioventricular block (19% and 24% in thrombolyed and not thrombolyzed patients respectively) but it seems that thrombolysis improves the outcome of these patients. The occurrence of atrioventricular block in acute inferior wall myocardial infarction is related to the presence of an important right coronary artery that is occluded, the recanalisation of this vessel leads often to rapid regression of the block that is no longer pejorative.
Ben Ameur
Y
Y
Service de cardiologie, hôpital Habib-Thameur, Montfleury CP 1008, Tunisie.
Mghaieth
F
F
Ouchallal
K
K
Hmem
M
M
Terras
M
M
Longo
S
S
Bouraoui
L
L
Kraïem
S
S
Slimane
M L
ML
D000208:Acute Disease; D003402:Creatine Kinase / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006327:Heart Block / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D013318:Stroke Volume; D015912:Thrombolytic Therapy
D003402:Creatine Kinase
Valeur pronostique du bloc auriculoventriculaire du deuxième et du troisième degré au cours de la phase aiguë de l'infarctus du myocarde inférieur.