Management of acute myocardial infarction complicated by advanced atrioventricular block. Role of artificial pacing.
Management of acute myocardial infarction complicated by advanced atrioventricular block. Role of artificial pacing.
复制标题
急性心肌梗死并发晚期房室传导阻滞的治疗。
DOI：
10.1016/0002-9149(69)90241-0
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发表时间：
1969
期刊：
影响因子：
--
通讯作者：
Douglas F. Allen
中科院分区：
文献类型：
--
作者：
Jonas Beregovich;Sidney Fenig;Jerry Lasser;Douglas F. Allen
对25例急性心肌梗死合并晚期房室传导阻滞患者进行了经静脉人工起搏治疗。18名患者存活（72%），包括一些有公认风险因素的患者，如前壁梗死、严重充血性心力衰竭、心源性休克、心脏传导阻滞复发、长期或持续性晚期房室传导阻滞、既往心肌梗死、心室自主机制、相关心律失常、晕厥发作和复苏程序。或使用电极导管未发生栓塞。9例患者在恢复窦性心律时观察到竞争期，其中1例似乎诱发了室性心动过速。应用按需起搏器可消除这一并发症，在下列情况下，建议早期插入经静脉电极导管：（1）正常窦性心律伴心室内传导障碍;（2）Ⅱ度房室传导阻滞，包括文氏节律;（3）Ⅲ度房室传导阻滞;（4）心脏骤停发作，第2、3、4组应开始主动起搏。单纯性P-R延长是一个有争议的导管插入指征，因为这些患者通常进展更慢，向先进的A-V阻滞，提供足够的时间插入电极导管，如果需要的话。电极导管应留在原位，在重新建立窦性心律后的3至4周内备用，以覆盖可能的心脏传导阻滞晚期复发。
Twenty-five patients with acute myocardial infarction and advanced atrioventricular block were treated with transvenous artificial pacing. Eighteen patients survived (72 per cent), including some with recognized factors of risk such as anterior wall infarction, severe congestive heart failure, cardiogenic shock, recurrent episodes of heart block, long standing or persistent advanced A-V block, previous myocardial infarction, idioventricular mechanism, associated arrhythmias, syncopal episodes and resuscitation procedures.Complications including perforation of the myocardium, infection, or embolization did not occur with the use of electrode catheters. Periods of competition were observed in 9 patients at the time of re-establishment of sinus rhythm, with ventricular tachycardia seemingly induced in 1 of them. The use of demand pacemakers should eliminate this complication.Early introduction of a transvenous electrode catheter is recommended in the following circumstances: (1) normal sinus rhythm associated with the emergence of intraventricular conduction disturbances; (2) second degree A-V block, including Wenckebach rhythm; (3) third degree A-V block; (4) episodes of cardiac arrest.Active pacing should be initiated in groups 2, 3 and 4. Simple P-R prolongation is a controversial indication for catheterization, since these patients usually progress more slowly towards advanced A-V block, providing enough time for insertion of an electrode catheter, should the need arise.Electrode catheters should be left in place, on a standby basis for an additional three to four weeks after re-establishment of sinus rhythm, in order to cover possible late recurrences of heart block.