Evaluation of Heart Block in Inferior Wall Myocardial Infarction in Context of Intervention: Temporary Pacemaker Implantation versus Conservative Medical Management, a Single Centre Experience from Eastern India

Background: Association between Inferior wall Myocardial infarction (IWMI) and various degree of heart block is well known. However most of these blocks are transient. Objective of this study was to re-evaluate the need of temporary pacemaker and their effectiveness versus conservative management in those patients. Methods: This is a Hospital Record based Observational Study. 276 Patients who were admitted with diagnosis of Acute Inferior wall myocardial infarction were treated properly and evaluated in detail. All data were analysed using SPSS and EPI software. Results: The Mean age of the study population was 59.18 yrs. Among all patients 33 were diabetic. 42 (15.21%) patients presented with AV conduction defect. 9 patients (27.27%) who were diabetic had an AV Block. This occurrence was found to be significant (Odds Ratio= 2.3864 [1.020-5.580], Chi sq= 4.222, p=0.039). In patients with Diabetes and AV Block, an Odds Ratio=0.2500 [0.013-4.729] was obtained in a comparison of TPI status and Hospital Stay outcomes. However, the association was not significant though a higher occurrence was found among diabetics (Odds ratio= 4.000 [0.837-19.102], p(1-tailed Fischer Exact)=0.078 . Among the 42 patients with AV Block, 15(35.71%) patients underwent Temporary Pacemaker Implantation due to unstable hemodynamic condition. Out of 42 patients with AV Block, 33 (78.57%) patients were alive during the period of their hospital stay and 9 (21.42%) were dead. Also, among the 16 patients who underwent TPI, 11(68.75%) were alive and 5(31.25%) were dead. (2 had associated Renal Diseases,1 was in CRF, 1 had dyselectrolytemia with Cardiogenic Shock and 1 had Fatal Arrhythmias. In this study, the average duration of block in patients with Inferior Wall AMI with AV Block was found to be 4 days. Conclusion: This study conclude that with timely usage of Thrombolytics and Anticoagulants, the necessity of TPI may be markedly reduced so as the complications. AV Block following Acute IWMI is more commn in diabetics and average duration is 4 days. If a Secondary Coronary Intervention is planned it should be preceded by a PPI. Further study in the form of a controlled trial is necessary to support our findings.