In patients with acute myocardial infarction and bilateral bundle-branch block, the high incidence of complete heart block (21%) and mortality (36%) suggests prophylactic temporary transvenous pacing is indicated.
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High mortality with complete heart block in acute MI and bilateral BBB; leaves open whether prophylactic pacing improves outcomes.
Over an 11-year period, 28 instances of acute myocardial infarction and bilateral bundle-branch block were encountered. Twenty-two of these patients had right bundle-branch block and left axis deviation, and six had right bundle-branch block and block of the inferior radiation of the left bundle. The overall incidence of complete heart block in these 28 cases was 21%. In-hospital mortality for the whole group was 36%, whereas it was 33% for those patients who developed complete heart block. From these results it is concluded that for the patient with bilateral bundle-branch block and acute myocardial infarction the prophylactic insertion of a temporary transvenous pacemaker is not only warranted, but is probably indicated.
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Scanlon et al. (1970) studied this question.
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