Alpman A, Güldal M, Erol C, Akgün G, Kervancioglu C, Sonel A, Akyol T
Department of Cardiology, Ankara University, Faculty of Medicine, Turkey.
Jpn Heart J. 1993 Mar;34(2):145-57. doi: 10.1536/ihj.34.145.
To determine the immediate and remote prognostic significance of bundle branch block (BBB) associated with acute myocardial infarction (AMI), 40 patients with AMI and BBB were studied. One hundred forty-four patients with AMI but without BBB were evaluated during the in-hospital phase and 45 of them were taken as a control group. These patients were followed for an average of 15 months (3-28 months). Arrhythmias and left ventricular function were investigated with 24-hr Holter monitoring and echocardiography, respectively. The hospital mortality was significantly greater in patients with BBB than in the control group (32.5% vs 10.4%, p < 0.001). The main cause of mortality was pump failure in the group with BBB (76.9%) and ventricular fibrillation in the control group (53.3%). The peak creatine kinase level was significantly higher in the group with BBB than in the control group (2094.8 +/- 288.4 IU/L vs 416.7 +/- 30.5 IU/L, p < 0.001). In patients with BBB prophylactic temporary pacemaker insertion was not found to improve the hospital mortality rate. In the hospital phase, although 32% of the patients with BBB had complicated arrhythmias (multiform, paired VPB, runs, R-on-T) the cause of death in 10 of the 13 patients who died was pump failure but not arrhythmia. In patients with BBB the wall motion index and the number of patients who had a left ventricular aneurysm were greater than in patients without BBB (9.5 +/- 0.9 vs 6.3 +/- 0.6, p < 0.01 and 52.0% vs 14.3%, p < 0.01, respectively). In patients with BBB follow-up mortality (12.0%) was lower than hospital mortality (32.5%). During the follow-up period there was no significant difference between patients with BBB and those without with regard to complicated arrhythmias (14.8% vs 15.6%). These results indicate that the main cause of poor prognosis during the hospital period in patients with AMI and BBB was not arrhythmia or conduction disturbance but severe pump failure due to extensive myocardial necrosis. Prophylactic temporary pacemaker insertion did not improve the hospital mortality rate of these patients, and patients with AMI and BBB who survive the in-hospital phase after infarction have a good prognosis during the following 15 months.
为确定与急性心肌梗死（AMI）相关的束支传导阻滞（BBB）的近期和远期预后意义，对40例AMI合并BBB患者进行了研究。144例AMI但无BBB的患者在住院期间接受了评估，其中45例作为对照组。这些患者平均随访15个月（3 - 28个月）。分别通过24小时动态心电图监测和超声心动图调查心律失常和左心室功能。BBB患者的院内死亡率显著高于对照组（32.5%对10.4%，p < 0.001）。死亡的主要原因在BBB组是泵衰竭（76.9%），在对照组是心室颤动（53.3%）。BBB组的肌酸激酶峰值水平显著高于对照组（2094.8±288.4 IU/L对416.7±30.5 IU/L，p < 0.001）。未发现对BBB患者预防性插入临时起搏器可提高院内死亡率。在住院阶段，虽然32%的BBB患者有复杂心律失常（多形性、成对室性早搏、连发、R-on-T），但13例死亡患者中有10例的死亡原因是泵衰竭而非心律失常。BBB患者的室壁运动指数和发生左心室室壁瘤的患者数量均高于无BBB的患者（分别为9.5±0.9对6.3±0.6，p < 0.01；52.0%对14.3%，p < 0.01）。BBB患者的随访死亡率（12.0%）低于院内死亡率（32.5%）。在随访期间，BBB患者和无BBB患者在复杂心律失常方面无显著差异（14.8%对15.6%）。这些结果表明，AMI合并BBB患者在住院期间预后不良的主要原因不是心律失常或传导障碍，而是广泛心肌坏死导致的严重泵衰竭。预防性插入临时起搏器并未提高这些患者的院内死亡率，并且AMI合并BBB且在梗死住院期存活的患者在随后15个月预后良好。
