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Endocardial Pacing in Heart Block Due to Acute Myocardial Infarction
Author(s) -
Sangster J. F.,
Craig R. J.,
Waddy J. L.,
Hetzel P. S.,
McPhie J. M.
Publication year - 1972
Publication title -
australian and new zealand journal of medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 0004-8291
DOI - 10.1111/j.1445-5994.1972.tb03921.x
Subject(s) - medicine , cardiogenic shock , myocardial infarction , heart block , atrioventricular block , infarction , cardiology , shock (circulatory) , heart failure , electrocardiography
Summary: Sixty‐five patients treated by temporary endocardial pacing for second and third degree heart block complicating acute myocardial infarction are reviewed. Sixteen had second degree block and 49 complete heart block. The overall in‐hospital mortality was 38%. The poor prognosis of anterior infarction and complete heart block was confirmed, and it was shown that clinical assessment of the patient prior to pacing related closely to the eventual outcome. ‘Late’ hospital deaths accounted for one‐third of the in‐hospital deaths, all of the patients dying in general wards after their electrode had been removed; two‐thirds of these deaths were unexpected and perhaps preventable. Only a marginal reduction in the mortality from complete heart block was achieved by a policy of routinely pacing every patient with this arrhythmia, but a marked reduction in mortality was achieved with second degree block. One death could be related to the procedure, but this occurred in a patient already in cardiogenic shock. It is concluded that a policy of routinely pacing all patients with high‐grade atrioventricular block following myocardial infarction is justified. The greatest benefits are seen in patients with second degree block, whereas the mortality is only slightly reduced in those with complete heart block. Patients who have been paced should have their electrodes left in position for at least three weeks, and they should be kept under close observation. This may help further reduce the mortality.