Circulation, Vol 58, 679-688, Copyright © 1978 by American Heart Association
MC Hindman, GS Wagner, M JaRo, JM Atkins, MM Scheinman, RW DeSanctis, AH Hutter Jr, L Yeatman, M Rubenfire, C Pujura, M Rubin and JJ Morris
To provide an understanding of the clinical characteristics of patients
with acute myocardial infarction (MI) and bundle branch block, experience
from five centers was accumulated. Patients in whom bundle branch block
first appeared after the onset of cardiogenic shock were excluded. In 432
patients, the most common types of block were left (38%) and right with
left anterior fascicular block (34%). In 42% of the patients, bundle branch
block was new. Progression to high degree (second or third degree)
atrioventricular (AV) block via a Type II pattern occurred in 22% of the
patients. Hospital and first year follow- up mortality rates were 28% and
28%, respectively. Only 46% of the patients developed pulmonary edema or
shock (Killip Class III or IV), and hospital mortality was related to the
amount of heart failure (8%, 7%, 27%, 83% for Killip Classes I-IV,
respectively). Patients with progression to second degree or third degree
AV block via a Type II pattern had increased hospital mortality compared
with patients without this complication (47% vs 23%, P less than 0.001). In
the absence of pulmonary edema or shock, patients with Type II second
degree or third degree AV block still had a higher mortality rate than
patients without advanced AV block (31% vs 2%, P less than 0.005), with
nearly all the deaths due to abrupt development of AV block. Thus, in many
patients MI with bundle branch block is associated with severe heart
failure. However, this was not true for a majority of the patients, in whom
therapy aimed at preventing morbidity and mortality due to the
bradyarrhythmia of advanced AV block might be beneficial.
ARTICLES
The clinical significance of bundle branch block complicating acute myocardial infarction. 1. Clinical characteristics, hospital mortality, and one-year follow-up
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