Impact of PercuSurge GuardWire Device on Prevention and Reduction of Recovery Time From Complete Heart Block in Patients With Acute Inferior Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Abstract

SUMMARYSecond-degree heart block or complete heart block (CHB) is a relatively frequent complication of acute inferior wall myocardial infarction (AIWMI). This study investigated whether the PercuSurge device can prevent procedure-related CHB or can shorten CHB recovery time in patients with AIWMI undergoing primary percutaneous coronary intervention (PCI). Between May 2002 and April 2005, a PercuSurge device was utilized in 113 patients (study population, group 1) with AIWMI due to obstruction of the right coronary artery (RCA) with a reference lumen diameter (RLD) ≥ 3.5 mm.The control subjects (group 2) consisted of 119 patients who experienced AIWMI due to RCA obstruction with a RLD ≥ 3.5 mm from May 2000 to April 2002. The combined incidence of new onset of CHB following the interventional procedure was significantly higher in group 2 than in group 1. Additionally, recovery time from CHB to first-degree heart block or normal sinus rhythm was remarkably longer in group 2 than in group 1. Furthermore, the duration of hospitalization in group 2 was significantly longer than in group 1. Multiple stepwise analyses demonstrated that the PercuSurge device was the only independent predictor of preventing new onset of CHB during the procedure. Additionally, this mechanical device along with final TIMI-3 flow and final myocardial blush grade ≥ 2 was independently associated with reducing recovery time from CHB. In conclusion, the PercuSurge device can prevent procedure-related CHB and shorten the recovery time for CHB in patients with AIWMI undergoing primary PCI. (Int Heart J 2007; 48: 35-44)

Primary percutaneous coronary intervention ameliorates complete atrioventricular block complicating acute inferior myocardial infarction

“… 1 In patients with inferior ST-segment elevation myocardial infarction (STEMI), CAVB has been reported to be as high as 28%. 2 – 4 The exact mechanism underlying AVB remains unclear, although the two most common explanations are interrupted blood flow to the AV node and increased vagal tone resulting from the Bezold–Jarish reaction. 5 , 6 In the thrombolytic era, CAVB in inferior AMI has been associated with older age, larger infarct size, and higher in-hospital mortality.…”