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

Abstract

ObjectiveComplete atrioventricular block (CAVB) in acute inferior ST-segment elevation myocardial infarction (STEMI) is associated with poor clinical outcomes after noninvasive treatment. This study was designed to determine the effect of primary percutaneous coronary intervention (PCI) in patients with CAVB complicating acute inferior STEMI, at a single center.MethodsWe enrolled 138 consecutive patients diagnosed with STEMI involving the inferior wall; of these, 27 patients had CAVB. All patients received primary PCI. The clinical characteristics, procedural data, and clinical outcomes were compared in patients with versus without CAVB.ResultsBaseline clinical characteristics were similar between patients with and without CAVB. Patients with CAVB were more likely to present with cardiogenic shock, and CAVB was caused primarily by right coronary artery occlusion. Door-to-balloon time was similar between those two groups. After primary PCI, CAVB was reversed in all patients. The peak creatinine phosphokinase level, left ventricular ejection fraction and in-hospital mortality rate were similar between the two groups. After a median follow up of 318 days, major adverse cardiac events did not differ between the groups (8.1% in patients without CAVB; 11.1% in patients with CAVB) (P=0.702).ConclusionWe conclude that primary PCI can ameliorate CAVB-complicated acute inferior STEMI, with an acceptable rate of major adverse cardiac events, and suggest that primary PCI should be the preferred reperfusion therapy in patients with CAVB complicating acute inferior myocardial infarction.

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

“…The mechanism of HAVB in inferior wall STEMI is not fully elucidated. However, as mentioned in our previous study, 20 we consider that the underlying major cause of bradyarrhythmia results from the cardioinhibitory (Bezold–Jarisch) reflexes arising from vagal efferent nerves in the ischemic ventricular wall. In this study, we investigated the prognostic significance of TP in 72 patients with inferior STEMI treated with primary PCI.…”

Atrioventricular block after acute myocardial infarction and its association with other clinical parameters in Pakistani patients: an institutional perspective

“…cardiogenic shock, intra-ventricular arrhythmias, and increased risk of in hospital mortality [14–16]. Experience with complete AV block in patients with STEMI have shown that CHB respond to atropine and isoproterenol in the vast majority of cases and usually it does not require even temporary pacing and almost never implantation of permanent pacemakers [17, 18]. However current guidelines have recommended that temporary pacing is indicated for symptomatic bradyarrythmias unresponsive to medical treatment [19].…”

Factors associated with temporary pacing insertion in patients with inferior ST-segment elevation myocardial infarction

“…In order to improve clinical outcomes in patients with AMI, it is essential to collect more specific data about each complication of AMI. High-degree atrioventricular block (HAVB) is a common complication following ST-segment elevation myocardial infarction (STEMI), the incidence of which is reported to be 2.7 to 19.6% [3][4][5][6][7]. Each complication of AMI depends on the size and anatomic location of the infarction, and HAVB is more common in inferior STEMI [3,4].…”