Ventricular Conduction Blocks and Sudden Death in Acute Myocardial Infarction

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Abstract
Of 425 patients with acute myocardial infarction admitted to a coronary-care unit 77 (18 per cent) had ventricular conduction blocks. Complete heart block developed in 43 per cent with right-bundle-branch block and left-axis deviation, in 17 per cent with left-bundle-branch block, and in 6 per cent without ventricular conduction blocks. In-hospital mortality was 30 per cent in patients with and 14 per cent without ventricular conduction block. Late sudden death occurred in five of six patients with right-bundle-branch block and left-axis deviation who had transient complete heart blocks during myocardial infarction, whereas eight similar patients with complete heart block with permanent pacing were alive. These findings suggest that patients with this form of block with an acute myocardial infarction should have temporary standby pacemakers inserted. If complete heart block develops in such cases in association with an acute myocardial infarction, even though transient, permanent pacing should be instituted.