Hindman M C, Wagner G S, JaRo M, Atkins J M, Scheinman M M, DeSanctis R W, Hutter A H, Yeatman L, Rubenfire M, Pujura C, Rubin M, Morris J J
Circulation. 1978 Oct;58(4):679-88. doi: 10.1161/01.cir.58.4.679.
To provide an understanding of the clinical characteristics of patients with acute myocardial infarction (MI) and bundle branch block, experience from five centers was accumulated. Patients in whom bundle branch block first appeared after the onset of cardiogenic shock were excluded. In 432 patients, the most common types of block were left (38%) and right with left anterior fascicular block (34%). In 42% of the patients, bundle branch block was new. Progression to high degree (second or third degree) atrioventricular (AV) block via a Type II pattern occurred in 22% of the patients. Hospital and first year follow-up mortality rates were 28% and 28%, respectively. Only 46% of the patients developed pulmonary edema or shock (Killip Class III or IV), and hospital mortality was related to the amount of heart failure (8%, 7%, 27%, 83% for Killip Classes I-IV, respectively). Patients with progression to second degree or third degree AV block via a Type II pattern had increased hospital mortality compared with patients without this complication (47% vs 23%, P less than 0.001). In the absence of pulmonary edema or shock, patients with Type II second degree or third degree AV block still had a higher mortality rate than patients without advanced AV block (31% vs 2%, P less than 0.005), with nearly all the deaths due to abrupt development of AV block. Thus, in many patients MI with bundle branch block is associated with severe heart failure. However, this was not true for a majority of the patients, in whom therapy aimed at preventing morbidity and mortality due to the bradyarrhythmia of advanced AV block might be beneficial.
为了解急性心肌梗死（MI）合并束支传导阻滞患者的临床特征，我们积累了来自五个中心的经验。排除心源性休克发作后首次出现束支传导阻滞的患者。在432例患者中，最常见的阻滞类型为左束支传导阻滞（38%）和合并左前分支阻滞的右束支传导阻滞（34%）。42%的患者束支传导阻滞为新发。22%的患者通过Ⅱ型模式进展为高度（二度或三度）房室（AV）传导阻滞。住院死亡率和第一年随访死亡率分别为28%和28%。仅46%的患者发生肺水肿或休克（Killip分级Ⅲ或Ⅳ级），住院死亡率与心力衰竭程度相关（Killip分级Ⅰ - Ⅳ级的死亡率分别为8%、7%、27%、83%）。与无此并发症的患者相比，通过Ⅱ型模式进展为二度或三度AV传导阻滞的患者住院死亡率增加（47%对23%，P < 0.001）。在无肺水肿或休克的情况下，Ⅱ型二度或三度AV传导阻滞患者的死亡率仍高于无严重AV传导阻滞的患者（31%对2%，P < 0.005），几乎所有死亡均因AV传导阻滞突然发生。因此，在许多MI合并束支传导阻滞的患者中，与严重心力衰竭相关。然而，对于大多数患者并非如此，针对预防严重AV传导阻滞所致缓慢性心律失常的发病率和死亡率的治疗可能有益。
