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(Circulation. 1972;46:753.)
© 1972 American Heart Association, Inc.

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Clinical and Anatomic Implications of Intraventricular Conduction Blocks in Acute Myocardial Infarction

M. SCHEINMAN M.D.¹ B. BRENMAN B.A.¹

¹ From the Medical Service, San Francisco General Hospital, and the Department of Medicine, University of California School of Medicine, San Francisco, California.

The electrocardiogram in 480 patients with acute myocardial infarction showed right bundle-branch block (RBBB) with normal QRS axis in 18 patients (3.7%), left bundle-branch block (LBBB) in 31 (8%), RBBB and left anterior hemiblock (LAH) in 23 (4.8%), RBBB and left posterior hemiblock (LPH) in four (1%), LAH alone in 20 (4%), LPH in one (0.2%), and no evidence of intraventricular conduction (I-V) disturbance in 383 (80%). Eighteen of the 97 patients with I-V block showed 1° A-V block, and seven of the 18 (39%) showed abrupt progression to high-grade A-V block, while only six of 79 (8%) without 1° A-V block showed similar progression.

Cause of death in patients with I-V block was cardiac failure and/or shock in 92%; only three instances of primary asystole occurred. The incidence of complete heart block was higher in the I-V disease group (15%) than in the group without block (5%), but not significantly. Patients with LAH or RBBB and LAH usually had occlusion of the left anterior descending artery with extensive septal infarction, while patients with RBBB or LBBB had a more variable pattern of vessel involvement. Presence of I-V block in patients with acute myocardial infarction implies a hectic clinical course with poor prognosis, but does not justify prophylactic temporary transvenous intracardiac pacing except perhaps in the subgroup with associated 1° A-V block.

Key Words: Right bundle-branch block • Left posterior hemiblock • Left bundle-branch block • Fascicular block • Left anterior hemiblock

Submitted on January 20, 1972
Accepted on May 23, 1972

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