PMID: 1193113Dec 1, 1975Paper

The clinical features and significance of bifascicular block complicating acute myocardial infarction.

European Journal of Cardiology
M R StephensJ R Muir

Abstract

Two series of patients with anterior myocardial infarction complicated by right bundle branch block with either left anterior hemiblock (RBBB+LAH) or left posterior hemiblock (RBBB+LPH), have been studied. The first was a retrospective analysis taken from a time when prophylactic pacing wires were not inserted, and the second was a prospective series in whom pacing wires were inserted as soon as the condition defect was seen. The overall prevalence of RBBB+LAH was 3.3% compared to 1.6% for RBBB+LPH, and complete atrioventricular block was seen in 36% of the former and 66% of the latter. From the retrospective data it was apparent that hospital death was usually associated with massive myocardial infarction, although 3 of the 25 patients in this series died in hospital from sudden development of complete atrioventricular block. If the defect was transitory (1-3 days) then the prognosis was that of acute anterior infarction uncomplicated by fascicular block. The policy of prophylactic pacing failed to show any overall change in hospital mortality, and only 3 patients survived long enough to have permanent pacemakers inserted. This procedure has been of benefit to only one of these cases.

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