ATRIOVENTRICULAR-BLOCK IN ACUTE INFERIOR WALL MYOCARDIAL-INFARCTION - HARBINGER OF ASSOCIATED OBSTRUCTION OF THE LEFT ANTERIOR DESCENDING CORONARY-ARTERY
ATRIOVENTRICULAR-BLOCK IN ACUTE INFERIOR WALL MYOCARDIAL-INFARCTION - HARBINGER OF ASSOCIATED OBSTRUCTION OF THE LEFT ANTERIOR DESCENDING CORONARY-ARTERY
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DOI：
10.1016/s0735-1097(86)80416-8
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发表时间：
1986-10-01
影响因子：
24
通讯作者：
SANTOS, M
中科院分区：
文献类型：
--
作者：
BASSAN, R;MAIA, IG;SANTOS, M
在一项前瞻性研究中，连续51例下壁心肌梗死急性期存活的患者接受了冠状动脉造影。11例患者在梗死急性期出现一定程度的房室（AV）阻滞，并在几天内消失，心电图分析认为其位于AV结。急性心肌梗死期间发生房室传导阻滞的患者冠状动脉左前降支阻塞的发生率显著高于无房室传导阻滞的患者（91%对55%，p < 0.05），并且73%的心脏传导阻滞患者和30%的无传导阻滞患者的阻塞发生在第一间隔穿支分支流出之前（p < 0.01）。急性下壁心肌梗死发生房室传导阻滞时左前降支阻塞的敏感性、特异性和预测值分别为31%、95%和91%，第一间隔穿支分支出口前阻塞的敏感性、特异性和预测值分别为40%、90%和73%。下壁心肌梗死合并冠状动脉左前降支阻塞的患者在梗死急性期发生心脏传导阻滞的几率是无左前降支阻塞的下壁心肌梗死患者的6倍（p < 0.05）。这些发现也支持了近端AV传导系统通常具有来自右冠状动脉和左冠状动脉前降支的双动脉血液供应的观察结果，并且可以解释这些患者中观察到的心脏传导阻滞的短暂行为和AV结坏死的缺乏。
In a prospective study 51 consecutive patients who survived the acute phase of inferior wall myocardial infarction underwent coronary arteriography. Eleven patients developed some degree of atrioventricular (AV) block in the acute phase of infarction that disappeared within a few days and was consider by electrocardiographic analysis to be located in the AV node. Patients with AV block during acute myocardial infarction had a significantly higher prevalence of left anterior descending coronary artery obstruction (91 versus 55%, p < 0.05) than did patients without AV block and the obstruction preceded the exit of the first septal perforator branch in 73% of cases with heart block and in 30% of cases without block (p < 0.01). The sensitivity, specificity and predictive values were 31, 95 and 91%, respectively, for the existence of left anterior descending coronary artery obstruction when AV block occurred during acute inferior myocardial infarction, and 40, 90 and 73%, respectively, for the occurrence of the coronary artery obstruction before the exit of the first septal perforator branch. Patients with inferior myocardial infarction and left anterior descending coronary artery obstruction have a sixfold greater chance of developing heart block in the acute phase of infarction than do patients with inferior infarction without such obstruction (p < 0.05). These findings also support the observations that the proximal AV conduction system usually has a dual arterial blood supply from both the right and left anterior descending coronary arteries, and may explain the transient behavior of heart block and lack of necrosis of the AV node seen in these patients.