INFERIOR WALL MYOCARDIAL-INFARCTION AND A TRIOVENTRICULAR-BLOCK - ANGIOGRAPHIC AND PROGNOSTIC FACTORS

This study was based on 42 cases of 2nd or 3rd degree atrioventricular block out of 292 cases of inferior wall myocardial infarction. The cr iteria of selection were monitoring in the intensive care unit during the acute phase, selective coronary angiography in the first 48 hours to 5 days, and regular clinical follow-up during the first year after infarction. The conduction defect was either immediately recorded on t he first ECG, delayed (between the 12th and 24th hour) or late (after the 3rd day). These 42 inferior wall infarcts with atrioventricular bl ock (incomplete in 14 and complete in 28 cases) differed from inferior infarction without block by : the severity of the clinical signs duri ng the acute phase (35 % with cardiac failure, 19 % with cardiogenic s hock) ; the severity of the coronary lesions (71.4 % with triple vesse l disease in infarction with atrioventricular block compared with 32 % in those without block, p < 0.02) ; the prevalence of the association of > 70 % stenosis of the right coronary and left anterior descending arteries ; the alteration of left ventricular function (53 % patients with atrioventricular block had ejection fraction of under 30 %) the severity of these infarcts was not related to die atrioventricular blo ck which regressed in 95 % of cases but to the severity of the coronar y disease, the left ventricular dysfunction and the advanced age of th e patients (72.3 +/- 8 years).