Postinfarction conduction abnormalities

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]

Overview

Ischemia of the conduction system results in conduction abnormalities in the heart. Atrioventricular blocks are common in inferior infarcts and intraventricular blocks are common in anterior wall infarcts.

Classification

Conduction abnormalities post-infarction can be classified as atrioventricular blocks and intraventricular blocks.

• Atriventricular blocks:
  • Second degree blocks (Mobitz type I and II)
  • Third degree

• Intraventricular block:
  • Bundle branch blocks
  • Bifascicular blocks

These blocks can be temporary or persistent.

Pathophysiology

Atrioventricular blocks

• High grade AV blocks (second and third degree blocks) occur in up to 20% of patients with inferior MI.
• AV blocks are common in inferior infarcts than in anterior infarcts by three fold. The frequency is even more when the right ventricle is involved in the inferior infarcts than when not involved.
• In majority of inferior infarcts the blocks are transient.
• Presence of Av blocks in anterior infarcts indicates a larger infarction and there is a significant increase in short term mortality compared to patients without AV block.
• Mechanisms on AV block include:
  • In inferior MI:
    • Increased parasympathetic tone
    • Ischemic stunning of AV node
    • Increased local potassium due to infarction
    • Increased local release of adenosine