Abstract
Eighty-two consecutive patients with a first inferior wall acute myocardial infarction were evaluated by radionuclide angiography and 24-hour Holter monitoring during their hospital stay. The patients were divided into two groups. The first group ( n = 28) had advanced atrioventricular block, while the second group ( n = 54) were without atrioventricular block. The patients with advanced block had lower left ventricular (49 ± 12% vs. 55 ± 14%, P < 0.05) and right ventricular ejection fraction (26 ± 10% vs. 43 ± 11%, P < 0.001) than those with normal atrioventricular conduction. The atrioventricular block disappeared spontaneously in all of them. The hospital mortality of the patients with advanced block and those without advanced block was 10.7 and 5.5%, respectively ( P = NS). Pre-discharge 24-hour Holter monitoring done in all survivors revealed isolated ventricular ectopics (Lown grade I, II, III) in 44% of patients who had had advanced block and 43.1% of patients without advanced block ( P = NS). Complex ventricular ectopics (Lown grade IVa, IVb), however, were recorded in significantly more patients with advanced block as compared to patients without advanced block (36 vs. 7.8%, P < 0.01). Most patients with complex ventricular ectopics in both groups had impaired left or right ventricular function. The follow-up of survivors (11 ± 6.2 months for those with advanced block and 10 ± 6.6 months for those without; P = NS) revealed that while the incidence of severe angina (12 vs. 9.8%) and a new myocardial infarction (8 vs. 7.8%) was not significantly different between the groups ( P = NS), the incidence of sudden death was significantly higher in patients with advanced block (12 vs. 0%, P < 0.01). We conclude that patients with acute inferior myocardial infarction and advanced atrioventricular block have lower left and right ventricular ejection fraction, possibly related to a larger infarct size. This results in a substrate for electrical instability, leading to a higher incidence of complex ventricular ectopics and sudden death in these patients.
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