Temporary pacing in ST-segment elevation myocardial infarction complicated with high degree atrioventricular block

Abstract

Introduction and objectivesTemporary pacemaker (TP) is used in patients with high-degree atrioventricular block (HAVB) and ST-segment elevation myocardial infarction (STEMI) to maintain cardiac output and prevent the onset of malignant arrhythmias. Our aim was to characterize the outcomes of patients with STEMI who require TP implantation in the primary angioplasty era. MethodsWe enrolled all consecutive patients with STEMI who underwent primary angioplasty from 2004 to 2017 in a tertiary care referral center. Patients with STEMI and HAVB who required TP implantation were analyzed. Patients with anterior and inferior STEMI were compared and a multivariate analysis was performed to identify mortality risk factors. All patients completed 30-day and 1-year follow-up. ResultsOf the 3063 patients in the study cohort, 180 (5.9%) had HAVB at the time of cardiac catheterization, and 114 (3.7%) underwent TP implantation. Thirty-day and 1-year mortality were 25.6% and 31.5%, respectively. Low left ventricle ejection fraction and impaired renal function showed independent association with mortality in this patient population. Patients with anterior STEMI who required TP had a ∼4-fold higher 30-day mortality than those with inferior STEMI (71% vs 18%; P≤.001). Only in 7% of patients a definitive pacemaker was finally implanted. ConclusionsPatients with STEMI and HAVB who require TP implantation, particularly those with anterior STEMI, are at high risk of adverse outcome. Low left ventricle ejection fraction and impaired renal function are independently associated with mortality. A definitive pacemaker implant is finally required in a small proportion of this patient population.