Why the study?
Inferior wall MI frequently stems from right coronary artery occlusion supplying the AV node, prompting the need to analyze high-degree AV block incidence alongside ventricular dysfunction and angiographic findings.
Does the presence of high-degree AV blocks in acute inferior wall myocardial infarction correlate with worse biventricular dysfunction and multivessel disease?
Does the presence of high-degree AV blocks in acute inferior wall myocardial infarction correlate with worse biventricular dysfunction and multivessel disease?
High-degree AV block in acute inferior wall myocardial infarction is a marker for more extensive myocardial damage, including severe biventricular dysfunction and multivessel coronary artery disease.
High-degree AV block in IWMI was associated with biventricular dysfunction and multivessel disease; leaves open whether targeted RV assessment improves outcomes.
Objectives: Inferior wall myocardial infarction (IWMI) accounts for about 50% of acute myocardial infarction (MI) which are caused predominantly by occlusion of the right coronary artery which also mostly supplies both the SinoAtrial and atrioventricular (AV) nodes. The objective of this study is to analyze the incidence of high-degree AV blocks in IWMI with respect to right ventricular (RV) MI, RV dysfunction, left ventricular (LV) dysfunction, and their angiographic correlation.Methods: This study was a hospital-based retrospective cross-sectional analytical study involving 150 patients presenting to our casualty with Acute IWMI during August 2016–February 2018. We have collected the demographic details of these patients and analyzed various complications pertaining to AV Blocks. The patients were categorized into two groups – Group 1-IWMI with high-degree AV blocks and Group 2-IWMI without AV blocks. In-depth history and other details such as electrocardiogram, ventricular dysfunction by echocardiogram and angiographic data were analyzed among these two groups.Results: Among 150 patients with acute IWMI, high-degree AV blocks were seen in 35 patients (23%). The mean age of presentation was 56–65 years (31.4%) with male preponderance (60%). Severe LV dysfunction (ejection fraction <30%) in Group 1 (60%) was statistically significant with P < 0.00001 when compared to Group 2 (17.3%). RV dysfunction (tricuspid annular plane systolic excursion <16 mm) is seen in 57.2% versus 4.3% cases in Group 1 which is statistically significant with P < 0.00001. The triple vessel disease was significant in Group 1 (57.1% vs. 17.3%) whereas single-vessel disease (8.5% vs. 43.5%) was significant in Group 2 with P < 0.00001. Reversal of AV block is seen in 94.2% of cases after recanalization of RCA. Mortality was more in Group 1 (5.8% vs. 2.6%).Conclusion: IWMI with high-degree AV block has a worse prognosis with increased incidence of RV and LV dysfunction and multivessel disease. Prompt intervention can reverse AV block in most of the cases.
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Iragavarapu et al. (2019) studied this question.
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