| Right bundle branch block of unknown age in the setting of acute anterior myocardial infarction: an attempt to define who should be paced prophylactically. | |
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MedLine Citation:
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PMID: 7479171 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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It is widely accepted that patients presenting with acute anterior myocardial infarction and acute onset of right bundle branch block should be prophylactically paced in contrast with those who have a chronic bundle branch block. The admitting physician is faced with the dilemma of how to act if the age of this conduction disturbance is unknown. This problem has further intensified in recent years, with the introduction of thrombolytic treatment, where insertion of a central vascular line is associated with increased morbidity. The objectives of this study were to define clinical or electrocardiographic parameters that may help the admitting physician to decide whether patients presenting with an anterior wall myocardial infarction and a right bundle branch block of unknown age should be prophylactically paced. We examined prospectively the in-hospital clinical course of 39 consecutive patients presenting with an acute myocardial infarction in whom the age of a right bundle branch block upon admission was unknown (group C, n = 39) and compared with two similar groups of patients who presented with an acute right bundle branch block (group A, n = 38) and with a known chronic right bundle branch block (group B, n = 22). Thirty-three patients (33%) died, with cardiogenic shock being the leading cause of death in the entire population. Prophylactic pacing, which was carried out in 66% and 54% of patients in groups A and C, respectively, did not reduce mortality rates. No clinical or electrocardiographic variables on admission were predictive to support prophylactic pacing in group C. In 10 of 46 (22%) patients who were prophylactically paced with a transvenous electrode, the following complications attributed to the procedure were detected: (1) either rapid sustained ventricular tachycardia (during implantation) that was unresponsive to overdrive pacing, or ventricular fibrillation necessitating electrical defibrillation (4 patients); (2) recurrent episodes of rapid nonsustained ventricular tachycardia, which stopped only after the pacemaker was turned off (1 patient); (3) complete AV block (1 patient); (4) fever appearing on the third or fourth day after implantation (3 patients); and (4) a large hematoma in the groin in 1 patient who was treated with thrombolysis shortly before pacemaker electrode insertion. Thus, the complications of transvenous temporary pacing in the era of thrombolysis may outweight any theoretical advantage. |
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Authors:
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A Roth; Y Borsuk; G Keren; D Sheps; A Glick; M Reicher; S Laniado |
Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: Pacing and clinical electrophysiology : PACE Volume: 18 ISSN: 0147-8389 ISO Abbreviation: Pacing Clin Electrophysiol Publication Date: 1995 Aug |
Date Detail:
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Created Date: 1995-12-07 Completed Date: 1995-12-07 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 7803944 Medline TA: Pacing Clin Electrophysiol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1496-508 Citation Subset: IM |
Affiliation:
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Department of Cardiology, Tel-Aviv Sourasky Medical Center, Israel. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Aged Bundle-Branch Block / complications*, prevention & control* Cardiac Pacing, Artificial* / adverse effects Case-Control Studies Catheterization, Central Venous Cause of Death Chronic Disease Decision Making Electric Countershock Electrocardiography Female Follow-Up Studies Forecasting Heart Block / etiology Humans Male Myocardial Infarction / complications*, drug therapy Prospective Studies Recurrence Shock, Cardiogenic / etiology Survival Rate Tachycardia, Ventricular / etiology Thrombolytic Therapy Ventricular Fibrillation / etiology |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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