Braun S, Baitsch G, Burkart F
Schweiz Med Wochenschr. 1978 Nov 4;108(44):1748-50.
The short- and long-term results of provisional pacemaker therapy in fresh myocardial infarction have been investigated. In this cardiac unit in the period 1975--1977 provisional pacemakers were implanted in 48 patients due to severe conduction disturbance or sinus node syndrome with non-tolerated heart failure. 16 patients had bifascicular block (11 anterior, 3 diaphragmatic, and 2 non-localizable infarctions): in 9 (56%) of them, progression to complete AV block occurred. 27 patients exhibited AV block of 2nd to 3rd degree without evidence of fascicular blockades (21 diaphragmatic, 3 anterior, and 3 non-localizable infarctions). In 5 patients, sinus node dysfunction was the reason for pacemaker implantation. Hospital mortality in the group was 31.2% and thus was twice as high as the hospital mortality in all patients hospitalized in this unit with myocardial infarction during the same period (16.5%). The hospital mortality in patients with anterior infarction was 57.2% compared with a mortality of 16.7% in patients with diaphragmatic infarction. Late mortality (18 months after myocardial infarction) in the group was 46.8%. None of the patients with diaphragmatic infarction died during this observation period. In the patient group with anterior infarction, the mortality rose to 85.8%. Of the 14 patients who died in hospital, death in 12 was due to severe heart failure: neither bradycardic nor tachycardic arrhythmias were immediate factors in death. At autopsy, all patients exhibited severe coronary sclerosis with extensive myocardial infarction. Only 2 patients died from arrhythmia (atrial fibrillation/asystole). In 6 of the 34 survivors, a definitive pacemaker was implanted. 3 of these patients died in the first year after the myocardial infarction. Death was sudden in all three.
对急性心肌梗死患者临时起搏器治疗的短期和长期效果进行了研究。1975年至1977年期间，在本心脏科，因严重传导障碍或伴有无法耐受的心力衰竭的窦房结综合征，为48例患者植入了临时起搏器。16例患者存在双分支阻滞（11例前壁梗死、3例膈面梗死和2例梗死部位无法确定）：其中9例（56%）进展为完全性房室传导阻滞。27例患者表现为二度至三度房室传导阻滞，无分支阻滞证据（21例膈面梗死、3例前壁梗死和3例梗死部位无法确定）。5例患者因窦房结功能障碍植入起搏器。该组患者的医院死亡率为31.2%，是同期该科室所有因心肌梗死住院患者医院死亡率（16.5%）的两倍。前壁梗死患者的医院死亡率为57.2%，而膈面梗死患者的死亡率为16.7%。该组患者的晚期死亡率（心肌梗死后18个月）为46.8%。在观察期内，膈面梗死患者均未死亡。在前壁梗死患者组中，死亡率升至85.8%。在14例住院死亡的患者中，12例死于严重心力衰竭：缓慢性或快速性心律失常均非直接死因。尸检时，所有患者均表现为严重冠状动脉硬化并伴有广泛心肌梗死。仅2例患者死于心律失常（心房颤动/心搏停止）。34例幸存者中有6例植入了永久性起搏器。其中3例患者在心肌梗死后第一年死亡。三例均为猝死。
