Left bundle branch block infarction with

Stenestrand U, Tabriz F, Lindback J, England A, Rosenqvist M, Wallentin L. Comorbidity and myocardial dysfunction are the main explanations for the higher 1-year mortality in acute myocardial infarction with left bundle-branch block. Circulation 2004 110 1896-902. 

Antman developed a thrombosis in myocardial infarction (TIMI) risk score based on a database of 15,078 patients with STEMI or new onset of complete left bundle branch block (8), The score was validated in the TIMI 9 data set. Ten characteristics of these patients accounted for 97% of the predictive capacity of their multivariate model. These are included in the risk score (Table I). Points were given for difference parameters as listed in Table I. The risk score had a strong association with 30-day mortality. There was a greater >40-fold increase in mortality from TIMI risk score 0 to >8 at 30 days (Table I) (8), The TIMI risk score is easy to apply and can be done at the bedside. 

Figure 3.40 (A) Acute phase of an infarction in a patient symmetrical T wave in III (mixed pattern of repolarisation with complete left bundle branch block. Note the clear abnormality) leads to the suspicion of associated...

Madias J, Sinha A, Ashtiani R. A critique of the new ST-segment criteria for the diagnosis of acute myocardial infarction in patients with left bundle-branch block. Clin Cardiol 2001 24 652. 

Preexisting second- or third-degree AV block, right bundle branch block when associated with a left hemiblock (bifascicular block), unless a pacemaker is present to sustain the cardiac rhythm if complete heart block occurs recent myocardial infarction (Ml) presence of cardiogenic shock hypersensitivity to the drug. 

Prophylactic Temporary Pacemaker Insertion. Approximately 1% of patients with acute myocardial infarction develop a Type n second-degree AV block. Although this rhythm is often tolerated hemodynamically, because there can be sudden progression to complete AV block, temporary pacing should be considered. New bundle-branch block (BBB) has been associated with an 18% risk of transient complete AV block (9-11). The development of BBB usually signifies an extensive infarction, typically involving the anterior wall. Death in these patients usually results from left ventricular pump failure, although 9% of deaths have been attributable to complete AV block (9). 

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