Aamir Javaid

Background: Acute myocardial infarction continues to be a major public health problem worldwide. Temporary pacing is needed in various situations of myocardial infarction. Objective: To determine in hospital outcome (electrical and mechanical complications) of acute myocardial infarction (MI) patients requiring temporary transvenous pacing. Patients and Methods: This descriptive case series was conducted at the Cardiology Department of the Punjab Institute of Cardiology, Lahore from October 2007 to April 2008.One hundred patients presenting with acute chest pain consistent with acute myocardial infarction, typical ECG changes and raised serum markers of myocardial infarction and requiring temporary pacing during their hospital stay were included. Results: A total of 100 patients were included in study. The mean age of the study population was 49.9±7.5 years. There were 85% males and 15% females. Majority of patients 66% were smokers. Diabetes mellitus and hypertension was observed in 45% patients. Mean duration of onset of symptoms till arrival at the hospital was 8.2±4.6 hours. Majority of patients 65% had inferior wall myocardial infarction (IWMI), 3% patients had IWMI with right ventricular MI. Extensive anterior wall myocardial infarction (AWMI) was observed in 25%. Anteroseptal wall MI occurred in 7% of patients. Streptokinase was used for thrombolysis in 76% patients. First degree heart block was noted in 2% patients at arrival. Second degree Mobitz type 1 occurred in 1% and Mobitz type 2 in 4%. Third degree or complete heart block was noted in 31% patients. Right bundle branch block with left anterior fascicular block occurred in 3% and trifascicular block in 4%. During hospital stay, complete heart block occurred on st nd 1 post MI day in 55% patients, and on 2 post MI day in 3% patients. Temporary pacemaker was implanted in 40% of patients at st nd presentation, in 57% of patients on 1 post MI day and in 3% on 2 post MI day. In-hospital mortality occurred in 8%, ventricular tachycardia in 29%, ventricular fibrillation in 2% and asystole in 2% patients. Conclusion: Complete heart block in patients with ST-Elevation myocardial infarction requiring temporary pacing is accompanied by a worse early prognosis. A more aggressive therapeutic approach aimed to reduce early mortality seems warranted in these patients.