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Current Cardiology Reviews

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ISSN (Print): 1573-403X
ISSN (Online): 1875-6557

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Review Article

Conduction Disorders in the Setting of Acute STEMI

Author(s): Kjell Nikus*, Yochai Birnbaum, Miquel Fiol-Sala, Jani Rankinen and Antoni Bayés de Luna

Volume 17, Issue 1, 2021

Published on: 02 July, 2020

Page: [41 - 49] Pages: 9

DOI: 10.2174/1573403X16666200702121937

Price: $65

Abstract

ST-elevation myocardial (STEMI) is frequently associated with conduction disorders. Regional myocardial ischemia or injury may affect the cardiac conduction system at various locations, and neural reflexes or changes in the balance of the autonomous nervous system may be involved. Sinoatrial and atrioventricular blocks are more frequent in inferior than anterior STEMI, while new left anterior fascicular block and right bundle branch block indicate proximal occlusion of the left anterior descending coronary artery. New left bundle branch block is associated with multi-vessel disease.

Most conduction disorders associated with STEMI are reversible with reperfusion therapy, but they may still impair prognosis because they indicate a large area at risk, extensive myocardial infarction or severe coronary artery disease.

Acute STEMI recognition is possible in patients with a fascicular or right bundle branch block, but future studies need to define the cut-off values for ST depression in the leads V1-V3 in inferolateral MI and for ST elevation in the same leads in anterior STEMI. In the left bundle branch block, concordant ST elevation is a specific sign of acute coronary artery occlusion, but the ECG feature has low sensitivity.

Keywords: Conduction disorder, acute coronary syndrome, acute myocardial infarction, bundle branch block, atrioventricular block, pacemaker.

Graphical Abstract

[1]
Zipes DP. The clinical significance of bradycardic rhythms in acute myocardial infarction. Am J Cardiol 1969; 24(6): 814-25.
[http://dx.doi.org/10.1016/0002-9149(69)90470-6] [PMID: 5360234]
[2]
Serrano CV Jr, Bortolotto LA, César LA, et al. Sinus bradycardia as a predictor of right coronary artery occlusion in patients with inferior myocardial infarction. Int J Cardiol 1999; 68(1): 75-82.
[http://dx.doi.org/10.1016/S0167-5273(98)00344-1] [PMID: 10077404]
[3]
Liem KL, Lie KI, Louridtz WJ, Durrer D, Wellens HJ. Sinus bradycardia in acute myocardial infarct. Ned Tijdschr Geneeskd 1976; 120(14): 604-8.
[PMID: 1256609]
[4]
Shah SP, Waxman S. Two cases of Bezold-Jarisch reflex induced by intra-arterial nitroglycerin in critical left main coronary artery stenosis. Tex Heart Inst J 2013; 40(4): 484-6.
[PMID: 24082386]
[5]
Vikse J, Henry BM, Roy J, et al. Anatomical Variations in the Sinoatrial Nodal Artery: A Meta-Analysis and Clinical Considerations. PLoS One 2016; 11(2): e0148331.
[http://dx.doi.org/10.1371/journal.pone.0148331] [PMID: 26849441]
[6]
Bayes de Luna AJ. Block at the auricular level. Rev Esp Cardiol 1979; 32(1): 5-10.
[PMID: 441485]
[7]
Bayés de Luna A, Platonov P, Cosio FG, et al. Interatrial blocks. A separate entity from left atrial enlargement: a consensus report. J Electrocardiol 2012; 45(5): 445-51.
[http://dx.doi.org/10.1016/j.jelectrocard.2012.06.029] [PMID: 22920783]
[8]
Çinier G, Tekkeşin AI, Genç D, et al. Interatrial block as a predictor of atrial fibrillation in patients with ST-segment elevation myocardial infarction. Clin Cardiol 2018; 41(9): 1232-7.
[http://dx.doi.org/10.1002/clc.23029] [PMID: 30022507]
[9]
Bruña V, Velásquez-Rodríguez J, Valero-Masa MJ, et al. Prognostic of Interatrial Block after an Acute ST-Segment Elevation Myocardial Infarction. Cardiology 2019; 142(2): 109-15.
[http://dx.doi.org/10.1159/000499501] [PMID: 31117073]
[10]
Álvarez-García J, Vives-Borrás M, Gomis P, et al. Electrophysiological Effects of Selective Atrial Coronary Artery Occlusion in Humans. Circulation 2016; 133(23): 2235-42.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.116.021700] [PMID: 27151531]
[11]
Kosmidou I, Redfors B, Dordi R, et al. Incidence, Predictors, and Outcomes of High-Grade Atrioventricular Block in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention (from the HORIZONS-AMI Trial). Am J Cardiol 2017; 119(9): 1295-301.
[http://dx.doi.org/10.1016/j.amjcard.2017.01.019] [PMID: 28267964]
[12]
Bayés de Luna A, Fiol-Sala M. Acute coronary syndrome: unstable angina and acute myocardial infarction. In: The surface electrocardiography in ischaemic heart disease: Clinical imaging correlations and prognostic implications Massachusets: Blackwell Futura. 2008; pp. 209-74.
[13]
Lie KI, Wellens HJ, Schuilenburg RM, Durrer D. Mechanism and significance of widened QRS complexes during complete atrioventricular block in acute inferior myocardial infarction. Am J Cardiol 1974; 33(7): 833-9.
[http://dx.doi.org/10.1016/0002-9149(74)90629-8] [PMID: 4829366]
[14]
Wellens HJJ, Gorgels APM, Doevendans PA. Conduction disturbances in acute myocardial infarction.In: Wellens HJJ, Gorgels APM, Doevendans PA The ECG in acute myocardial infarction and unstable angina Diagnosis and risk stratification. Dordrecht, the Netherlands: Kluwer Academic Publishers 2003; pp. 43-64.
[15]
Birnbaum Y, Sclarovsky S, Herz I, et al. Admission clinical and electrocardiographic characteristics predicting in-hospital development of high-degree atrioventricular block in inferior wall acute myocardial infarction. Am J Cardiol 1997; 80(9): 1134-8.
[http://dx.doi.org/10.1016/S0002-9149(97)00628-0] [PMID: 9359538]
[16]
Berger PB, Ryan TJ. Inferior myocardial infarction. High-risk subgroups. Circulation 1990; 81(2): 401-11.
[http://dx.doi.org/10.1161/01.CIR.81.2.401] [PMID: 2404629]
[17]
Alnsasra H, Ben-Avraham B, Gottlieb S, et al. High-grade atrioventricular block in patients with acute myocardial infarction. Insights from a contemporary multi-center survey. J Electrocardiol 2018; 51(3): 386-91.
[http://dx.doi.org/10.1016/j.jelectrocard.2018.03.003] [PMID: 29550105]
[18]
Kim KH, Jeong MH, Ahn Y, Kim YJ, Cho MC, Kim W. Other Korea acute myocardial infarction registry investigators. differential clinical implications of high-degree atrioventricular block complicating st-segment elevation myocardial infarction according to the location of infarction in the Era of Primary Percutaneous Coronary Intervention. Korean Circ J 2016; 46(3): 315-23.
[http://dx.doi.org/10.4070/kcj.2016.46.3.315] [PMID: 27275168]
[19]
Aguiar Rosa S, Timóteo AT, Ferreira L, et al. Complete atrioventricular block in acute coronary syndrome: prevalence, characterisation and implication on outcome. Eur Heart J Acute Cardiovasc Care 2018; 7(3): 218-23.
[http://dx.doi.org/10.1177/2048872617716387] [PMID: 28617040]
[20]
Kosmidou I, Redfors B, McAndrew T, et al. Worsening atrioventricular conduction after hospital discharge in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: the HORIZONS-AMI trial. Coron Artery Dis 2017; 28(7): 550-6.
[http://dx.doi.org/10.1097/MCA.0000000000000525] [PMID: 28644212]
[21]
Ibanez B, James S, Agewall S, et al. ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018; 39(2): 119-77.
[http://dx.doi.org/10.1093/eurheartj/ehx393] [PMID: 28886621]
[22]
O’Gara PT, Kushner FG, Ascheim DD, et al. American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013; 127(4): e362-425.
[http://dx.doi.org/10.1161/CIR.0b013e3182742c84] [PMID: 23247304]
[23]
Engelen DJ, Gorgels AP, Cheriex EC, et al. Value of the electrocardiogram in localizing the occlusion site in the left anterior descending coronary artery in acute anterior myocardial infarction. J Am Coll Cardiol 1999; 34(2): 389-95.
[http://dx.doi.org/10.1016/S0735-1097(99)00197-7] [PMID: 10440150]
[24]
Pérez-Riera AR, Barbosa-Barros R, Daminello-Raimundo R, de Abreu LC, Tonussi Mendes JE, Nikus K. Left posterior fascicular block, state-of-the-art review: A 2018 update. Indian Pacing Electrophysiol J 2018; 18(6): 217-30.
[http://dx.doi.org/10.1016/j.ipej.2018.10.001] [PMID: 30326266]
[25]
Sclarovsky S, Sagie A, Strasberg B, Lewin RF, Rehavia E, Agmon J. Transient right axis deviation during acute anterior wall infarction or ischemia: electrocardiographic and angiographic correlation. J Am Coll Cardiol 1986; 8(1): 27-31.
[http://dx.doi.org/10.1016/S0735-1097(86)80087-0] [PMID: 3711528]
[26]
Pérez-Riera AR, Barbosa-Barros R, Daminello-Raimundo R, de Abreu LC, Nikus K. The tetrafascicular nature of the intraventricular conduction system. Clin Cardiol 2019; 42(1): 169-74.
[http://dx.doi.org/10.1002/clc.23093] [PMID: 30294894]
[27]
Pérez-Riera AR, Barbosa-Barros R, Lima Aragão W, et al. Transient left septal fascicular block in the setting of acute coronary syndrome associated with giant slurring variant J-wave. Ann Noninvasive Electrocardiol 2018; 23(6): e12536.
[http://dx.doi.org/10.1111/anec.12536] [PMID: 29476573]
[28]
Pérez-Riera AR, Barbosa-Barros R. Fernandes Silva E Sousa Neto A, Daminello-Raimundo R, de Abreu LC, Nikus K. Transient prominent anterior QRS forces in the setting ST segment elevation coronary syndrome: Left septal fascicular block. J Electrocardiol 2018; 51(5): 798-800.
[http://dx.doi.org/10.1016/j.jelectrocard.2018.06.006] [PMID: 30177315]
[29]
Frink RJ, James TN. Normal blood supply to the human His bundle and proximal bundle branches. Circulation 1973; 47(1): 8-18.
[http://dx.doi.org/10.1161/01.CIR.47.1.8] [PMID: 4686608]
[30]
Fiol M, Carrillo A, Rodríguez A, Pascual M, Bethencourt A, Bayés de Luna A. Electrocardiographic changes of ST-elevation myocardial infarction in patients with complete occlusion of the left main trunk without collateral circulation: differential diagnosis and clinical considerations. J Electrocardiol 2012; 45(5): 487-90.
[http://dx.doi.org/10.1016/j.jelectrocard.2012.05.001] [PMID: 22672790]
[31]
Sclarovsky S, Lewin RF, Strasberg B, Agmon J. Left anterior hemiblock obscuring the diagnosis of right bundle branch block in acute myocardial infarction. Circulation 1979; 60(1): 26-32.
[http://dx.doi.org/10.1161/01.CIR.60.1.26] [PMID: 445729]
[32]
Xiang L, Zhong A, You T, Chen J, Xu W, Shi M. Prognostic Significance of Right Bundle Branch Block for Patients with Acute Myocardial Infarction: A Systematic Review and Meta-Analysis. Med Sci Monit 2016; 22: 998-1004.
[http://dx.doi.org/10.12659/MSM.895687] [PMID: 27017617]
[33]
Thygesen K, Alpert JS, Jaffe AS, et al. ESC Scientific Document Group. Fourth universal definition of myocardial infarction (2018). Eur Heart J 2019; 40(3): 237-69.
[http://dx.doi.org/10.1093/eurheartj/ehy462] [PMID: 30165617]
[34]
Widimsky P, Rohác F, Stásek J, et al. Primary angioplasty in acute myocardial infarction with right bundle branch block: should new onset right bundle branch block be added to future guidelines as an indication for reperfusion therapy? Eur Heart J 2012; 33(1): 86-95.
[http://dx.doi.org/10.1093/eurheartj/ehr291] [PMID: 21890488]
[35]
Neumann JT, Sörensen NA, Rübsamen N, et al. Right bundle branch block in patients with suspected myocardial infarction. Eur Heart J Acute Cardiovasc Care 2019; 8(2): 161-6.
[http://dx.doi.org/10.1177/2048872618809700] [PMID: 30362813]
[36]
Sgarbossa EB, Pinski SL, Barbagelata A, et al. Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. GUSTO-1 (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) Investigators. N Engl J Med 1996; 334(8): 481-7.
[http://dx.doi.org/10.1056/NEJM199602223340801] [PMID: 8559200]
[37]
Tabas JA, Rodriguez RM, Seligman HK, et al. Electrocardiographic criteria for detecting acute myocardial infarction in patients with left bundle branch block: a meta-analysis. Ann Emerg Med 2008; 52(4): 329-36.
[http://dx.doi.org/10.1016/j.annemergmed.2007.12.006]
[38]
Lopes RD, Siha H, Fu Y, et al. Diagnosing acute myocardial infarction in patients with left bundle branch block. Am J Cardiol 2011; 108(6): 782-8.
[http://dx.doi.org/10.1016/j.amjcard.2011.05.006] [PMID: 21726838]
[39]
Smith SW, Dodd KW, Henry TD, Dvorak DM, Pearce LA. Diagnosis of ST-elevation myocardial infarction in the presence of left bundle branch block with the ST-elevation to S-wave ratio in a modified Sgarbossa rule. Ann Emerg Med 2012; 60(6): 766-76.
[http://dx.doi.org/10.1016/j.annemergmed.2012.07.119] [PMID: 22939607]
[40]
Wackers FJT, Lie KJ, David G, et al. Assessment of the value of electrocardiographic signs for myocardial infarction in left bundle branch block. In: Wellens HJJ, Kulbertus HE, Eds. What’s new in electrocardiography? Springer, Dordrecht. The Hague, The Netherlands: Martinus Nijhoff 1981; pp. 37-57.
[http://dx.doi.org/10.1007/978-94-009-8239-0_3]
[41]
Pera VK, Larson DM, Sharkey SW, et al. New or presumed new left bundle branch block in patients with suspected ST-elevation myocardial infarction. Eur Heart J Acute Cardiovasc Care 2018; 7(3): 208-17.
[http://dx.doi.org/10.1177/2048872617691508] [PMID: 29064258]
[42]
Mehta N, Huang HD, Bandeali S, Wilson JM, Birnbaum Y. Prevalence of acute myocardial infarction in patients with presumably new left bundle-branch block. J Electrocardiol 2012; 45(4): 361-7.
[http://dx.doi.org/10.1016/j.jelectrocard.2012.04.006] [PMID: 22575807]
[43]
Erne P, Iglesias JF, Urban P, et al. Left bundle-branch block in patients with acute myocardial infarction: Presentation, treatment, and trends in outcome from 1997 to 2016 in routine clinical practice. Am Heart J 2017; 184: 106-13.
[http://dx.doi.org/10.1016/j.ahj.2016.11.003] [PMID: 28224924]
[44]
Nestelberger T, Cullen L, Lindahl B, et al. APACE, ADAPT and TRAPID-AMI Investigators. Diagnosis of acute myocardial infarction in the presence of left bundle branch block. Heart 2019; 105(20): 1559-67.
[http://dx.doi.org/10.1136/heartjnl-2018-314673] [PMID: 31142594]

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