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The Factors Associated With Fascicular Block in Acute Anteroseptal Infarction

The Factors Associated With Fascicular Block in Acute Anteroseptal Infarction Abstract • To elucidate the genesis and effect of fascicular block, 131 patients with acute Q-wave anteroseptal infarction were studied. Thirty-seven patients had new onset of fascicular block in the coronary care unit. The hospital mortality rate was 16%. Multivariate analysis was performed to determine the Important variables related to the occurrence of fascicular block and hospital mortality based on 17 clinical variables obtained at the time of hospital admission. Serum potassium level and heart rate were the significant factors predicting the occurrence of fascicular block, whereas cardiac output and arterial oxygen tension were important for hospital mortality. Therefore, not only the rise in the heart rate but also the effect of the serum potassium level on the conduction system are independent factors related to the occurrence of fascicular block, and fascicular block in itself has no significant influence on the hospital mortality. (Arch Intern Med 1988;148:529-533) References 1. Norris RM, Croxson MS: Bundle branch block in acute myocardial infarction. Am Heart J 1970;79:728-733.Crossref 2. Scheinman M, Brenman B: Clinical and anatomic implications of intraventricular conduction blocks in acute myocardial infarction. Circulation 1972;46:753-760.Crossref 3. Col JJ, Weinberg SL: The incidence and mortality of intraventricular conduction defects in acute myocardial infarction. Am J Cardiol 1972; 29:344-350.Crossref 4. Waugh RA, Wagner GS, Haney TL, et al: Immediate and remote prognostic significance of fascicular block during acute myocardial infarction. Circulation 1973;47:765-775.Crossref 5. Lie KI, Wellens HJ, Schuilenburg RM, et al: Factors influencing prognosis of bundle branch block complicating acute antero-septal infarction: The value of His bundle recordings. Circulation 1974;50:935-941.Crossref 6. Rizzon P, Di Biase M, Baissus C: Intraventricular conduction defects in acute myocardial infarction. Br Heart J 1974;36:660-668.Crossref 7. Nimetz AA, Shubrooks SJ Jr, Hutter AM Jr, et al: The significance of bundle branch block during acute myocardial infarction. Am Heart J 1975;90:439-444.Crossref 8. Jones ME, Terry G, Kenmure ACF: Frequency and significance of conduction defects in acute myocardial infarction. Am Heart J 1977;94:163-167.Crossref 9. Hindman MC, Wagner GS, JaRo M, et al: The clinical significance of bundle branch block complicating acute myocardial infarction: I. Clinical characteristics, hospital mortality, and one-year follow-up. Circulation 1978;58:678-688. 10. Paes de Carvalho A: Role of potassium ions in the electrophysiological behavior of mammalian cardiac muscle , in Bajusz E (ed): Electrolytes and Cardiovascular Disease . New York, S Karger AG, 1965, pp 55-69. 11. Jackrel J, Miller JA, Schechter FG, et al: Atrioventricular conduction following ligation of the anterior septal artery in the dog: An electrocardiographic, histopathologic and histochemical study. Am J Cardiol 1970; 25:552-561.Crossref 12. Hackel DB, Wagner G, Ratliff NB, et al: Anatomic studies of the cardiac conducting system in acute myocardial infarction. Am Heart J 1972;83:77-81.Crossref 13. Spodick DH: Q-wave infarction versus S-T infarction. Am J Cardiol 1983;51:913-915.Crossref 14. Rosenbaum MB, Elizari MV, Lazzari JO: The Hemiblocks . Oldsmar, Fla, Tampa Tracings, 1970, pp 259-268. 15. Hecht HH, Kossmann CE, Childers RW, et al: Atrioventricular and intraventricular conduction: Revised nomenclature and concepts. Am J Cardiol 1973;31:232-244.Crossref 16. The Criteria Committee of the New York Heart Association: Nomenclature and Criteria for Diagnosis of Disease of the Heart and Great Vessels , ed 8. Boston, Little Brown & Co Inc, 1979, pp 237-248. 17. Gibson RS, Bishop HL, Stamm RB, et al: Value of early two dimensional echocardiography in patients with acute myocardial infarction. Am J Cardiol 1982;49:1110-1119.Crossref 18. Luck JC, Engel TR: Transient right bundle branch block with `SwanGanz' catheterization. Am Heart J 1976;92:263-264.Crossref 19. Castellanos A, Ramirez AV, Mayorga-Cortes A, et al: Left fascicular blocks during right-heart catheterization using the Swan-Ganz catheter. Circulation 1981;64:1271-1276.Crossref 20. Jennings RB, Sommers HM, Kaltenbach JP, et al: Electrolyte alterations in acute myocardial ischemic injury. Circ Res 1964;14:260-269.Crossref 21. Hirche HJ, Franz C, Bös R, et al: Myocardial extracellular K+ and H+ increase and noradrenaline release as possible cause of early arrhythmias following acute coronary artery occlusion in pigs. J Mol Cell Cardiol 1980;12:579-593.Crossref 22. Friedrich R, Hirche H, Kebbel U, et al: Changes of extracellular Na+, K+, Ca2+, and H +, of the ischemic myocardium in pigs. Basic Res Cardiol 1981;76:453-456.Crossref 23. Gettes LS, Hill JL, Saito T, et al: Factors related to vulnerability to arrhythmias in acute myocardial infarction. Am Heart J 1982;103:667-672.Crossref 24. Struthers AD, Reid JL, Whitesmith R, et al: Effect of intravenous adrenaline on electrocardiogram, blood pressure and serum potassium. Br Heart J 1983;49:90-93.Crossref 25. Weiss JL, Bulkley BH, Hutchins GM, et al: Two-dimensional echocardiographic recognition of myocardial injury in man: Comparison with postmortem studies. Circulation 1981;63:401-408.Crossref 26. Wyatt HL, Meerbaum S, Heng MK, et al: Experimental evaluation of the extent of myocardial dyssynergy and infarct size by two-dimensional echocardiography. Circulation 1981;63:607-614.Crossref 27. Lieberman AN, Weiss JL, Jugdutt BI, et al: Two-dimensional echocardiography and infarct size: Relationship of regional wall motion and thickening to the extent of myocardial infarction in the dog. Circulation 1981;63:739-746.Crossref 28. Sugiura T, Iwasaka T, Ogawa A, et al: Atrial fibrillation in acute myocardial infarction. Am J Cardiol 1985;56:27-29.Crossref 29. Solomon RJ, Cole AG: Importance of potassium in patients with acute myocardial infarction. Acta Med Scand , 1981, (suppl 647) , pp 87-93. 30. Nordrehaug JE, Johannessen KA, von der Lippe G: Serum potassium concentration as a risk factor of ventricular arrhythmias early in acute myocardial infarction. Circulation 1985;71:645-649.Crossref 31. Mackenzie GJ, Taylor SH, Flenley DC, et al: Circulatory and respiratory studies in myocardial infarction and cardiogenic shock. Lancet 1964;287:825-832.Crossref 32. Valencia A, Burgess JH: Arterial hypoxemia following acute myocardial infarction. Circulation 1969;40:641-652.Crossref 33. Fillmore SJ, Guimaraes AC, Scheidt SS, et al: Blood-gas changes and pulmonary hemodynamics following acute myocardial infarction. Circulation 1972;45:583-591.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

The Factors Associated With Fascicular Block in Acute Anteroseptal Infarction

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Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1988.00380030035008
Publisher site
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Abstract

Abstract • To elucidate the genesis and effect of fascicular block, 131 patients with acute Q-wave anteroseptal infarction were studied. Thirty-seven patients had new onset of fascicular block in the coronary care unit. The hospital mortality rate was 16%. Multivariate analysis was performed to determine the Important variables related to the occurrence of fascicular block and hospital mortality based on 17 clinical variables obtained at the time of hospital admission. Serum potassium level and heart rate were the significant factors predicting the occurrence of fascicular block, whereas cardiac output and arterial oxygen tension were important for hospital mortality. Therefore, not only the rise in the heart rate but also the effect of the serum potassium level on the conduction system are independent factors related to the occurrence of fascicular block, and fascicular block in itself has no significant influence on the hospital mortality. (Arch Intern Med 1988;148:529-533) References 1. Norris RM, Croxson MS: Bundle branch block in acute myocardial infarction. Am Heart J 1970;79:728-733.Crossref 2. Scheinman M, Brenman B: Clinical and anatomic implications of intraventricular conduction blocks in acute myocardial infarction. Circulation 1972;46:753-760.Crossref 3. Col JJ, Weinberg SL: The incidence and mortality of intraventricular conduction defects in acute myocardial infarction. Am J Cardiol 1972; 29:344-350.Crossref 4. Waugh RA, Wagner GS, Haney TL, et al: Immediate and remote prognostic significance of fascicular block during acute myocardial infarction. Circulation 1973;47:765-775.Crossref 5. Lie KI, Wellens HJ, Schuilenburg RM, et al: Factors influencing prognosis of bundle branch block complicating acute antero-septal infarction: The value of His bundle recordings. Circulation 1974;50:935-941.Crossref 6. Rizzon P, Di Biase M, Baissus C: Intraventricular conduction defects in acute myocardial infarction. Br Heart J 1974;36:660-668.Crossref 7. Nimetz AA, Shubrooks SJ Jr, Hutter AM Jr, et al: The significance of bundle branch block during acute myocardial infarction. Am Heart J 1975;90:439-444.Crossref 8. Jones ME, Terry G, Kenmure ACF: Frequency and significance of conduction defects in acute myocardial infarction. Am Heart J 1977;94:163-167.Crossref 9. Hindman MC, Wagner GS, JaRo M, et al: The clinical significance of bundle branch block complicating acute myocardial infarction: I. Clinical characteristics, hospital mortality, and one-year follow-up. Circulation 1978;58:678-688. 10. Paes de Carvalho A: Role of potassium ions in the electrophysiological behavior of mammalian cardiac muscle , in Bajusz E (ed): Electrolytes and Cardiovascular Disease . New York, S Karger AG, 1965, pp 55-69. 11. Jackrel J, Miller JA, Schechter FG, et al: Atrioventricular conduction following ligation of the anterior septal artery in the dog: An electrocardiographic, histopathologic and histochemical study. Am J Cardiol 1970; 25:552-561.Crossref 12. Hackel DB, Wagner G, Ratliff NB, et al: Anatomic studies of the cardiac conducting system in acute myocardial infarction. Am Heart J 1972;83:77-81.Crossref 13. Spodick DH: Q-wave infarction versus S-T infarction. Am J Cardiol 1983;51:913-915.Crossref 14. Rosenbaum MB, Elizari MV, Lazzari JO: The Hemiblocks . Oldsmar, Fla, Tampa Tracings, 1970, pp 259-268. 15. Hecht HH, Kossmann CE, Childers RW, et al: Atrioventricular and intraventricular conduction: Revised nomenclature and concepts. Am J Cardiol 1973;31:232-244.Crossref 16. The Criteria Committee of the New York Heart Association: Nomenclature and Criteria for Diagnosis of Disease of the Heart and Great Vessels , ed 8. Boston, Little Brown & Co Inc, 1979, pp 237-248. 17. Gibson RS, Bishop HL, Stamm RB, et al: Value of early two dimensional echocardiography in patients with acute myocardial infarction. Am J Cardiol 1982;49:1110-1119.Crossref 18. Luck JC, Engel TR: Transient right bundle branch block with `SwanGanz' catheterization. Am Heart J 1976;92:263-264.Crossref 19. Castellanos A, Ramirez AV, Mayorga-Cortes A, et al: Left fascicular blocks during right-heart catheterization using the Swan-Ganz catheter. Circulation 1981;64:1271-1276.Crossref 20. Jennings RB, Sommers HM, Kaltenbach JP, et al: Electrolyte alterations in acute myocardial ischemic injury. Circ Res 1964;14:260-269.Crossref 21. Hirche HJ, Franz C, Bös R, et al: Myocardial extracellular K+ and H+ increase and noradrenaline release as possible cause of early arrhythmias following acute coronary artery occlusion in pigs. J Mol Cell Cardiol 1980;12:579-593.Crossref 22. Friedrich R, Hirche H, Kebbel U, et al: Changes of extracellular Na+, K+, Ca2+, and H +, of the ischemic myocardium in pigs. Basic Res Cardiol 1981;76:453-456.Crossref 23. Gettes LS, Hill JL, Saito T, et al: Factors related to vulnerability to arrhythmias in acute myocardial infarction. Am Heart J 1982;103:667-672.Crossref 24. Struthers AD, Reid JL, Whitesmith R, et al: Effect of intravenous adrenaline on electrocardiogram, blood pressure and serum potassium. Br Heart J 1983;49:90-93.Crossref 25. Weiss JL, Bulkley BH, Hutchins GM, et al: Two-dimensional echocardiographic recognition of myocardial injury in man: Comparison with postmortem studies. Circulation 1981;63:401-408.Crossref 26. Wyatt HL, Meerbaum S, Heng MK, et al: Experimental evaluation of the extent of myocardial dyssynergy and infarct size by two-dimensional echocardiography. Circulation 1981;63:607-614.Crossref 27. Lieberman AN, Weiss JL, Jugdutt BI, et al: Two-dimensional echocardiography and infarct size: Relationship of regional wall motion and thickening to the extent of myocardial infarction in the dog. Circulation 1981;63:739-746.Crossref 28. Sugiura T, Iwasaka T, Ogawa A, et al: Atrial fibrillation in acute myocardial infarction. Am J Cardiol 1985;56:27-29.Crossref 29. Solomon RJ, Cole AG: Importance of potassium in patients with acute myocardial infarction. Acta Med Scand , 1981, (suppl 647) , pp 87-93. 30. Nordrehaug JE, Johannessen KA, von der Lippe G: Serum potassium concentration as a risk factor of ventricular arrhythmias early in acute myocardial infarction. Circulation 1985;71:645-649.Crossref 31. Mackenzie GJ, Taylor SH, Flenley DC, et al: Circulatory and respiratory studies in myocardial infarction and cardiogenic shock. Lancet 1964;287:825-832.Crossref 32. Valencia A, Burgess JH: Arterial hypoxemia following acute myocardial infarction. Circulation 1969;40:641-652.Crossref 33. Fillmore SJ, Guimaraes AC, Scheidt SS, et al: Blood-gas changes and pulmonary hemodynamics following acute myocardial infarction. Circulation 1972;45:583-591.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Mar 1, 1988

References