Publication Date
1-1-2021
Journal
Current Cardiology Reviews
DOI
10.2174/1573403X16666200702121937
PMID
32614749
PMCID
PMC8142368
PubMedCentral® Posted Date
1-17-2021
PubMedCentral® Full Text Version
Post-print
Published Open-Access
yes
Keywords
Bundle-Branch Block, Electrocardiography, Female, Heart Conduction System, Humans, Male, ST Elevation Myocardial Infarction, 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.