Clinical and angiographic findings of complete atrioventricular block in acute inferior myocardial infarction.
BACKGROUND
The angiographic findings and prognosis of patients with complete atrioventricular block (AVB) complicating acute inferior myocardial infarction (MI) remain unclear.


METHODS
The clinical and angiographic findings of 70 consecutive patients with complete AVB were compared with those of 319 patients with inferior MI without AVB (control group) admitted within the same study period.


RESULTS
Patients with complete AVB were older (68 +/- 12 vs 63 +/- 13 years; P = 0.004) and clustered with clinical features indicative of larger infarct size, such as right ventricular infarction, cardiogenic shock, or low left ventricular ejection fraction (LVEF). The onset of the complete AVB was observed within 24 hours in 62 (88.6%), preceded by second-degree AVB in 26 (37.1%) and the escape QRS complex was wide in 8 (11.4%) patients. In patients with complete AVB, a dominant right coronary artery occlusion was found in >95% of cases and in-hospital mortality was increased (27.1% vs 10.7%; P = 0.000), especially in those with widen QRS escape rhythm (75.0%). Reperfusion therapy had a positive impact on the natural course of complete AVB.


CONCLUSIONS
Complete AVB in acute inferior MI was associated with advanced age and larger infarct size. Complete AVB was virtually always caused by dominant right coronary artery occlusion. The in-hospital mortality was significantly higher, but improved by reperfusion therapy. No permanent pacemaker is performed at a mean follow-up of 47 months.
Jim
Man-Hong
MH
Cardiac Medical Unit, Grantham Hospital, Hong Kong, University of Hong Kong. jimmanh2002@yahoo.com
Chan
Annie O O
AO
Tse
Hung-Fat
HF
Barold
Serge S
SS
Lau
Chu-Pak
CP
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D054537:Atrioventricular Block / Q000150:complications* / Q000000981:diagnostic imaging* / Q000401:mortality; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D056989:Inferior Wall Myocardial Infarction / Q000150:complications* / Q000000981:diagnostic imaging* / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged