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Two-decade-long trends (1975-1997) in the incidence, hospitalization, and long-term death rates associated with complete heart block complicating acute myocardial infarction: A community-wide perspective

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AMERICAN HEART JOURNAL 2003年第3期145卷 500-507页

作者： Spencer, FA Jabbour, S Lessard, D Yarzebski, J Ravid, S Zaleskas, V Hyder, M Gore, JM Goldberg, RJ Univ Massachusetts Sch Med Dept Med Div Cardiovasc Med Worcester MA 01655 USA Lown Cardiovasc Res Fdn Brookline MA USA

Background The purpose of this community-wide study was to describe a >2-decade-long experience (1975-97) in the incidence and death rates associated with complete heart block (CHB) in patients with acute myocardial infarction (AMI). Limited population-based: data exist describing recent, and changes with time therein, incidence and case-fatality rates associated with CHB complicating AMI. Methods We conducted an observational study of 9082 metropolitan Worcester, Mass, residents (1990 census 437,000) hospitalized with validated AMI in all greater Worcester hospitals during 11 1-year periods between 1975 and 1997. Results Overall, CHB developed in 5.0 % of patients with AMI. The incidence rates of CHB declined in the periods studied (6.0% in 1975/78 vs 3.1 % in 1997). Declines in the occurrence of CHB were noted in patients with anterior or inferior/posterior MI. These trends remained after adjustment for other factors that might affect the risk of CHB. Patients in whom CHB developed experienced significantly higher hospital death rates than patients in whom CHB did not develop (46.8% vs.14.6%). However, improving trends in the hospital survival rate of patients with CHB were observed between 1975/78 (47.4% surviving) and 1997 (61.3% surviving). Patients in whom CHB developed during hospitalization were not at increased risk for dying after hospital discharge. Conclusions our findings indicate that the incidence of CHB complicating AMI has declined with time. The hospital prognosis of patients in whom CHB developed has improved, but these patients remain at an increased risk of hospital mortality. The long-term prognosis of patients with inferior MI and CHB is similar to that of patients in whom CHB did not develop. Patients with anterior MI and CHB may beat an increased risk of long-term mortality.

关键词：急性病共病现象心脏传导阻滞/诊断心脏传导阻滞/流行病学心脏传导阻滞/死亡率医院死亡率/发展趋势住院/统计学和数值数据住院/发展趋势发病率纵向研究马萨诸塞/流行病学死亡率/发展趋势心肌梗死/诊断心肌梗死/流行病学存活率分析老年人女(雌)性人类男(雄)性

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PROGNOSIS OF RIGHT BUNDLE-BRANCH BLOCK AND LEFT ANTERIOR-HEMIBLOCK AFTER INTRACARDIAC REPAIR OF TETRALOGY OF FALLOT

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AMERICAN HEART JOURNAL 1975年第5期90卷 549-554页

作者： CAIRNS, JA DOBELL, ARC GIBBONS, JE TESSLER, I MONTREAL CHILDRENS HOSP DEPT CARDIOLMONTREALQUEBECCANADA MCGILL UNIV MONTREALQUEBECCANADA

One hundred and forty-one survivors of intracardiac repair of tetralogy of Fallot (TOF), operated on between 1958 and 1972, were studied in order to document the incidence of right bundle branch block and left anterior hemiblock (RBBB and LAH) and to define the late prognosis. RBBB and LAH occurred in 31 patients (22 per cent), all of whom have had complete follow-up. Transient complete heart block (CHB) occurred postoperatively in 2 patients; there were no other significant arrhythmias. Two late deaths have occurred, neither from arrhythmia (one from progressive congestive heart failure, and the other from attempted reclosure of a ventricular septal defect). The remainder of the patients are well an average of 76 months postoperatively (range, 144 to 12 months). The absence of late-onset CHB or sudden death in this series contrasts with relatively high incidence of these events in some studies of RBBB and LAH after intracardiac repair of TOF. However, in those reports a history of transient postoperative CHB (indicative of trifascicular disease in this setting) can be found in 75 per cent of those who developed late-onset CHB or died suddenly. We conclude that the occurrence of RBBB and LAH after intracardiac repair of TOF does not of itself carry a bad late prognosis. The critical factor in a bad late prognosis in patients with ECG evidence of RBBB and LAH may be the history of transient postoperative CHB.

关键词：束支传导阻滞/诊断束支传导阻滞/病因学束支传导阻滞/死亡率心电描记术心脏传导阻滞/诊断心脏传导阻滞/病因学心脏传导阻滞/死亡率方法手术后并发症预后法乐四联症/外科学青少年儿童学龄前女(雌)性人类婴儿男(雄)性

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Relation between mode of pacing and long-term survival in the very elderly

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第5期33卷 1208-1216页

作者： Jahangir, A Shen, WK Neubauer, SA Ballard, DJ Hammill, SC Hodge, DO Lohse, CM Gersh, BJ Hayes, DL Mayo Clin & Mayo Fdn Div Cardiovasc Dis & Internal Med Rochester MN 55905 USA Mayo Clin & Mayo Fdn Clin Epidemiol Sect Rochester MN 55905 USA Mayo Clin & Mayo Fdn Biostat Sect Rochester MN 55905 USA

OBJECTIVES This study analyzes the relationship between pacing mode and long-term survival in a large group of very elderly patients (greater than or equal to 80 years old). BACKGROUND The relationship between pacing mode and long-term survival is not clear. Because the number of very elderly who are candidates for pacing is increasing, issues related to pacemaker (PM) use in the elderly have important clinical and economic implications. METHODS We retrospectively reviewed 432 patients (mean age, 84.5 +/- 3.9 years) who received their initial PM (ventricular in 310 and dual chamber in 122) between 1980 and 1992. Follow-up was complete (3.5 +/- 2.6 years). Observed survival was estimated by the Kaplan-Meier method. Age- and gender-matched cohorts from the Minnesota population were used for expected survival. Log-rank test and Cox regression hazard model were used for univariate and multivariate analyses. RESULTS Patients with ventricular PMs appeared to have poor overall survival compared with those with dual-chamber PMs. Observed survival after PM implantation in high grade atrioventricular block (AVB) patients was significantly worse than expected survival of the age- and gender-matched population (p < 0.0001), whereas observed survival of patients with sinus node dysfunction was not significantly different from expected survival of the matched population (p = 0.413). By univariate analysis, ventricular pacing in patients with AVE appeared to be associated with poor survival compared with dual-chamber pacing (hazard ratio [HR] 2.08;95% cofidence interval [CI] 1.33 to 3.33). After multivariate analysis, this difference was no longer significant (HR 1.41;95% CI 0.88 to 2.27). Independent predictors of all-cause mortality were number of comorbid illnesses, New York Heart Association functional class, left ventricular depression and older age at implant. Pacing mode was not an independent predictor of overall survival. Older age at implantation, diabetes mellitus, deme

关键词：心律失常窦性/死亡率心律失常窦性/病理生理学心律失常窦性/治疗心动过缓/死亡率心动过缓/病理生理学心动过缓/治疗心脏起搏人工/死亡率心脏起搏人工/标准死亡原因随访研究心脏传导阻滞/死亡率心脏传导阻滞/病理生理学心脏传导阻滞/治疗明尼苏达/流行病学预后回顾性研究存活率老年人老年人 80以上女(雌)性人类男(雄)性

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Comparison of results of early reperfusion in patients with inferior wall acute myocardial infarction with and without complete atrioventricular block

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第6期84卷 731-+页

作者： Kimura, K Kosuge, M Ishikawa, T Shimizu, M Hongo, Y Sugiyama, M Tochikubo, O Umemura, S Yokohama City Univ Sch Med Crit Care & Emergency Med Ctr Minami Ku Yokohama Kanagawa 2320024 Japan Yokohama City Univ Sch Med Dept Internal Med 2 Minami Ku Yokohama Kanagawa 2320024 Japan

Complete atrioventricular (AV) block is a frequent complication of inferior wall acute myocardial infarction (AMI) that is associated with a high incidence of in-hospital morbity and mortality.(1-8) Although reperfusion could influence outcome in patients who have complete AV block with inferior wall AMI,(1,8,9) available data do not clearly demonstrate that thrombolytic therapy reduces the relative risk of mortality.(3) This study compared results of early reperfusion between patients who had inferior wall AMI with and without complete AV block.

关键词：血管成形术经腔经皮冠状动脉冠状血管造影术心电描记术便携式心脏传导阻滞/死亡率心脏传导阻滞/治疗心肌梗死/死亡率心肌梗死/治疗心肌再灌注损伤/死亡率心肌再灌注损伤/治疗存活率分析血栓溶解疗法治疗结果成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Enhanced frequency of autoimmune congenital heart block in female offspring

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RHEUMATOLOGY 1999年第4期38卷 380-382页

作者： Dörner, T Feist, E Chaoui, R Hiepe, F Humboldt Univ Charite Dept Med 3 Berlin Germany Humboldt Univ Charite Dept Obstet & Gynecol Berlin Germany Deutsch Rheumaforschungszentrum Berlin Germany

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The significance of bundle branch block during acute myocardial infarction

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American Heart Journal 1975年第4期90卷 439-444页

作者： Nimetz, Allen A. Shubrooks Jr., Samuel J. Hutter Jr., Adolph M. DeSanctis, Roman W. Department of Medicine Harvard Medical School Boston MA United States the Cardiac Unit Massachusetts General Hospital Boston MA United States

Analysis of the course of 71 patients with acute myocardial infarction complicated by bundle branch block (BBB) confirms a high incidence of atrioventricular (A-V) block (42 per cent) and severe pump failure (35 per cent) in these patients. Hospital mortality was not correlated with BBB per se, but rather with the associated development of second or third degree A-V block (57 per cent with A-V block vs. 12 per cent without A-V block;p < .0005) or severe pump failure (35 per cent with vs. 11 per cent without severe pump failure;p < .001). However, late mortality was high and not significantly different among those surviving hospitalization whether transient A-V block was present or absent. Eight of 11 late deaths were sudden. Temporary pacing could not be shown to alter hospital survival statistically, but made the onset of complete heart block a hemodynamically smooth and clinically undetectable event in several patients who later survived. The place of permanent pacing in these patients cannot be clearly determined on the basis of this study or in the available literature. More data obtained either by pooling the experience of several centers or from a prospective randomized study are needed to determine the indications for permanent pacemakers. © 1975.

关键词：束支传导阻滞/病因学束支传导阻滞/治疗猝死心脏传导阻滞/病因学心脏传导阻滞/死亡率心脏传导阻滞/治疗心肌梗死/并发症心肌梗死/病理学心脏起搏器人工休克心原性/死亡率成年人老年人女(雌)性人类男(雄)性中年人

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