Conduction abnormalities after myocardial infarction
- Peter J Zimetbaum, MD
Peter J Zimetbaum, MD
- Section Editor — Cardiac Arrhythmias
- Associate Professor of Medicine
- Harvard Medical School
- Mark E Josephson, MD
Mark E Josephson, MD
- Professor of Medicine
- Harvard Medical School
- Section Editors
- Bradley P Knight, MD, FACC
Bradley P Knight, MD, FACC
- Section Editor — Cardiac Arrhythmias
- Professor of Medicine
- Feinberg School of Medicine, Northwestern University
- Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
- Editor-in-Chief — Cardiovascular Medicine
- Section Editor — Coronary Heart Disease; Myopericardial Disease
- Professor of Medicine
- Mayo Medical School
- James Hoekstra, MD
James Hoekstra, MD
- Section Editor — Adult Cardiology Emergencies
- Professor and Fredrick Glass Chair
- Wake Forest University
Bradyarrhythmias and conduction disturbances are well-recognized complications of acute myocardial infarction (MI). They are induced by either autonomic imbalance or ischemia and necrosis of the conduction system. It is important to recognize which bradyarrhythmias are transient and which are likely to progress to irreversible and symptomatic high-degree block.
The major conduction abnormalities associated with acute MI will be reviewed here; tachyarrhythmias, the other major dysrhythmic complication of MI, are discussed separately. (See "Supraventricular arrhythmias after myocardial infarction" and "Clinical features and treatment of ventricular arrhythmias during acute myocardial infarction".)
Issues related to LBBB — There are two specific issues related to left bundle branch block (LBBB) in association with an acute MI:
●LBBB can complicate the electrocardiographic diagnosis of MI. (See "Electrocardiographic diagnosis of myocardial infarction in the presence of bundle branch block or a paced rhythm".)
●Patients with a new or presumably new LBBB are treated as if they have an ST elevation MI . (See "Overview of the acute management of ST elevation myocardial infarction".)
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- Issues related to LBBB
- Limitations of incidence and prognosis data
- ANATOMY AND BLOOD SUPPLY OF THE CONDUCTION SYSTEM
- Blood supply
- FREQUENCY OF HIGH-DEGREE BLOCK WITH ACUTE MI
- Multicenter retrospective reviews
- MILIS trial
- Thrombolysis trials
- Non-ST elevation MI
- CONDUCTION DISTURBANCES AND INFARCT LOCATION
- Inferior MI
- Anterior MI
- MORTALITY AND HEART BLOCKS
- High degree AV block
- Bundle branch block
- - Increased comorbidities
- - New versus chronic BBB
- - ST segment changes
- - Distant prior MI
- MANAGEMENT OF HEART BLOCK
- Use of atropine
- Use of cardiac pacing
- Indications for temporary transvenous pacing
- - Standard indications
- - Special circumstances
- Indications for permanent pacing
- - Implantable cardioverter-defibrillator
- - Cardiac resynchronization therapy
- - AV synchrony
- - Managed ventricular pacing