Jones M E, Terry G, Kenmure A C
Am Heart J. 1977 Aug;94(2):163-7. doi: 10.1016/s0002-8703(77)80275-5.
The frequency of intraventricular conduction defects was determined in 556 consecutive patients with proven acute myocardial infarction. Complete left bundle branch block was present in 23 patients and carried a high mortality rate (61 per cent). Complete right buldle branch block was the rarest defect to be seen in isolation (8 patients) and carried a lower mortality rate (38%). Lone left anterior hemiblock was present in 72 patients and was associated with a low mortality rate (13 per cent); left posterior hemiblock occurred in 32 patients (mortality rate 19 per cent). In a further 59 patients right bundle branch block with left anterior or posterior hemiblock in addition was present and these patients had a high mortality rate which was greater than isolated right bundle branch block or hemiblock alone. Complete atrioventricular block developed in 51 patients, 26 of whom had prior evidence of intraventricular conduction defect. Despite the use of temporary transvenous pacing, mortality in patients who developed complete heart block was significantly increased whether or not an intraventricular conduction defect was already present. The significance of these findings for the management of patients with myocardial infarction is discussed.
对556例经证实为急性心肌梗死的连续患者进行了心室传导缺陷发生率的测定。23例患者出现完全性左束支传导阻滞，死亡率很高（61%）。完全性右束支传导阻滞是最罕见的单独出现的缺陷（8例患者），死亡率较低（38%）。72例患者存在孤立性左前分支阻滞，死亡率较低（13%）；32例患者出现左后分支阻滞（死亡率19%）。另有59例患者除右束支传导阻滞外还伴有左前或左后分支阻滞，这些患者的死亡率很高，高于单独的右束支传导阻滞或分支阻滞。51例患者发生了完全性房室传导阻滞，其中26例先前有室内传导缺陷的证据。尽管使用了临时经静脉起搏，但无论是否已经存在室内传导缺陷，发生完全性心脏传导阻滞的患者死亡率均显著增加。讨论了这些发现对心肌梗死患者治疗的意义。
