Title:Conduction Disorders in the Setting of Acute STEMI
Volume: 17
Issue: 1
Author(s): Kjell Nikus*, Yochai Birnbaum, Miquel Fiol-Sala, Jani Rankinen and Antoni Bayés de Luna
Affiliation:
- Department of Cardiology, Heart Center, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere University, Tampere,Finland
Keywords:
Conduction disorder, acute coronary syndrome, acute myocardial infarction, bundle branch block, atrioventricular
block, pacemaker.
Abstract:
ST-elevation myocardial (STEMI) is frequently associated with conduction disorders.
Regional myocardial ischemia or injury may affect the cardiac conduction system at various locations,
and neural reflexes or changes in the balance of the autonomous nervous system may be involved.
Sinoatrial and atrioventricular blocks are more frequent in inferior than anterior STEMI,
while new left anterior fascicular block and right bundle branch block indicate proximal occlusion
of the left anterior descending coronary artery. New left bundle branch block is associated with
multi-vessel disease.
Most conduction disorders associated with STEMI are reversible with reperfusion therapy, but they
may still impair prognosis because they indicate a large area at risk, extensive myocardial infarction
or severe coronary artery disease.
Acute STEMI recognition is possible in patients with a fascicular or right bundle branch block, but
future studies need to define the cut-off values for ST depression in the leads V1-V3 in inferolateral
MI and for ST elevation in the same leads in anterior STEMI. In the left bundle branch block, concordant
ST elevation is a specific sign of acute coronary artery occlusion, but the ECG feature has
low sensitivity.
