Frequency of Complete Atrioventricular Block Complicating ST-Elevation Myocardial Infarction in Patients Undergoing Primary Percutaneous Coronary Intervention

Abstract

Objectives: ST-segment elevation myocardial infarction (STEMI) can be associated with many conduction disturbances including complete atrioventricular block (CAVB). CAVB complicating STEMI resulted in an increased mortality before the modern era of primary percutaneous coronary intervention (PCI). The aim of this study was to ascertain the rate and risk factors for CAVB in STEMI patients undergoing rapid reperfusion with PCI. Methods: We analyzed 223 patients presenting with STEMI. Patient characteristics, procedural characteristics, and in-hospital data were compared between patients with and without CAVB. Results: Out of 223 patients, 174 underwent PCI; the majority (87%) was African-American. CAVB was present in 8 patients (4.6%), and 6 of them had RCA occlusion. Independent predictors of CAVB included diabetes mellitus, female gender, lower systolic and diastolic blood pressure, and inferior-lateral/lateral STEMI. Ten patients (5.7%) required temporary pacing at presentation; only 1 patient required permanent pacing before discharge. No patient with anterior STEMI developed CAVB. Conclusions: The incidence and in-hospital mortality rate of CAVB in patients with STEMI who underwent primary PCI was reduced when compared to data from the thrombolytic era. This may be due to faster flow recovery in the infarct-related artery achieved with PCI.

The impact of the complete atrioventricular block on in-hospital and long-term mortality in patients treated with primary percutaneous coronary intervention

“…The incidence of complete AV block, the clinical characteristics of the patients, as well as the percentage of patients with an implanted temporary pacemaker (PM) are in keeping with the findings found in literature which relate to patients treated with pPCI (1,2,6,13). Complete AV block complicating STEMI in the pPCI era is most commonly registered at admission, as a part of acute ischemia.…”

“…However, the difference disappeared after a year, which is why there was no difference in the mortality between the analyzed groups in the period between year one and year three of follow-up (13). Although most studies indicate that, in the pPCI era, complete AV predominantly affects intrahospital mortality in patients with STEMI, in a study by Chera et al, complete AV block was not found to be an independent predictor of in-hospital mortality (6). A similar finding can be found in a study by Lee et al, where the prognostic impact of complete AV block in patients with STEMI was analyzed, and it was not found that complete AV block influenced in-hospital mortality (14).…”

“…Upon the opening of the RCA, AV conduction in these patients usually normalizes. In patients with LAD occlusion, ischemia is usually infra-Hisian, the escape rhythm is usually unstable, which is why implanting a temporary PM is necessary in these patients (2,3,4,6,14,15,16,17,18). In the present study, all the patients who had anterior STEMI and complete AV block had a temporary pacemaker implanted.…”

“…Complete AV block is registered two to four times mor*+e frequently in patients with STEMI of the inferior wall than in patients with different STEMI localization. According to data found in literature, around 28% of inferior wall STEMIs are complicated by complete AV block (2,3,4,5,6).…”

Atrioventricular Conduction Disorders as a Complication of Inferior ST-Elevation Myocardial Infarction in Patients with COVID-19 Infection

“…In the current modern era of primary percutaneous coronary intervention, the incidence and in-hospital mortality rate of complete atrioventricular block in patients with STEMI who underwent primary PCI was reduced compared to the data from the thrombolytic era, and the incidence of complete atrioventricular block (CAVB) dropped to 3.2 and 4.6% [ 16 ] and 3.2% [ 17 ] in 2 separate studies. The risk factors of CAVB are age, worse Killip class at presentation, female sex, smoking, hypertension, and diabetes [16.17].…”