Periprocedural temporary pacing in primary percutaneous coronary intervention for patients with acute inferior myocardial infarction

Abstract

ObjectiveHigh-degree atrioventricular block (AVB), including complete AVB in acute inferior ST-elevation myocardial infarction (STEMI), is not uncommon. However, there is no study evaluating the clinical differences between patients who have undergone temporary pacing (TP) and patients who have not. The present study was designed to investigate whether TP has any prognostic significance in inferior STEMI complicated by complete AVB.MethodsFrom January 2009 to December 2014, 295 consecutive patients diagnosed with inferior wall STEMI in a university hospital were reviewed. All of them underwent primary percutaneous coronary intervention (PCI). Among the 295 patients, there were 72 patients with complete AVB. The clinical characteristics, procedural data, and long-term major adverse cardiocerebrovascular events were compared in patients with and without TP.ResultsBaseline clinical and procedural characteristics were similar between patients with and without TP. Patients with TP were more likely to present with cardiogenic shock; thus, additional interventions were attempted via a femoral approach, as patients received further treatment with intra-aortic balloon pumps and were subjected to additional cardiopulmonary resuscitation. Most cases of complete AVB were primarily caused by right coronary artery occlusion. After a median follow-up period of 344 (range, 105.5–641) days, major adverse cardiocerebrovascular events did not differ between the groups (P=0.528).ConclusionWe conclude that primary PCI without TP is acceptable in complete AVB-complicated acute inferior STEMI. To avoid delay in reperfusion, we suggest that primary PCI should be the first priority therapy rather than treating patients initially with TP.

Myocardial Injury After Temporary Transvenous Cardiac Pacing

“…As Hwang and others report, in acute inferior STEMI and high-degree atrioventricular block, periprocedural TTCP for primary percutaneous coronary intervention does not decrease the incidence of adverse cardiocerebrovascular events and thus is more likely to increase the incidence of cardiogenic shock and prolong hospitalization. 22 An analysis of >360,000 patients who underwent TTCP in the United States between 2004 and 2014 concluded that TTCP is generally safe with low pericardial complication rates (0.6%). 13 However, the in-hospital mortality rate (>10%) and strikingly high mortality rate (>50%) over 4 years of follow-up are concerning and suggest the need to identify other complications and alterations of TTCP.…”

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

“…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.…”

Arrhythmias After Acute Myocardial Infarction

“…These patients were discharged on antiplatelet therapy alone. Risk of subsequent atrial fibril-high-grade AV block complicating AMI is reperfusion therapy [82]. For patients with symptomatic or hemodynamically significant AV block in the setting of MI that is likely due to block at the AV node, atropine is a reasonable intervention [54].…”

“…Dopamine and epinephrine may be considered in the unstable patient. Aminophylline has shown promise in a small case series, but rigorous data are lacking [47][48][49][50][51][52][53][54][75][76][77][78][79][80][81][82][83]. Temporary pacing is indicated for patients presenting with AMI with significant bradycardia or AV block that is medically refractory or associated with ongoing symptoms [54].…”