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The Preventive Cardiac Pacing is Not Beneficial to the Patients with Acute Inferior Wall Myocardiac Infarction in the Treatment of Emergency PCI

Author: WangLiJun
Tutor: LinHaiLong
School: Dalian Medical University
Course: Internal Medicine
Keywords: Acute inferior wall myocardial infarction Temporary pacing Emergency PCI Reperfusion Malignant ventricular arrhythmias
CLC: R542.22
Type: Master's thesis
Year: 2008
Downloads: 64
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Abstract

The purpose of this article by a retrospective analysis of acute inferior myocardial infarction (referred to as acute inferior wall myocardial infarction) received percutaneous coronary intervention inpatient treatment (percutaneous coronary intervention PCI) in patients with various clinical data to explore temporary pacing of malignant ventricular arrhythmia disorders (causing hemodynamic abnormalities, ventricular tachycardia, ventricular fibrillation), impact protective temporary pacing on reperfusion reaction and reperfusion hypotension alleviate the effects of time and drug use. Methods 2000-2007 Dalian Central Hospital, Dalian City Friendship Hospital acute inferior wall myocardial infarction and successful completion of the emergency PCI hospitalized patients with 219 cases, which did not undergo temporary pacing in patients with 158 cases the line temporary pacing patients with a total of 61 cases ( reperfusion before pacing in 56 cases, five cases pacing) after reperfusion. Pacing, heart rate (HR) ≥ 50 beats / min (including the use of atropine and other drugs HR ≥ 50 beats / min) and before reperfusion pacing as a protective temporary pacing, a total of 45 cases; before pacing HR lt; 50 beats / min in the reperfusion before pacing by reperfusion for the HR lt; 50 beats / min line temporary pacemaker as required temporary pacing, a total of 16 cases. Patients with temporary pacing protective protective pacing group required temporary pacing patients required pacing group. Protective pacing group patients according to the reperfusion heart rate is divided into the normal heart protective pacing low heart rate, pacing protective group; protective pacing after reperfusion in patients with systolic blood pressure (SBP) lt; 90mmHg or before reperfusion the SBP the lt; 90mmHg reperfusion further reduce the inclusion of 25% or more protective pacing reperfusion hypotension group. All the outstanding pacing therapy in patients with non-pacing group. Non-pacing group patients according to the reperfusion heart rate is divided into a low heart rate group with non-pacing pacing normal heart rate group; non-pacing in patients with reperfusion SBP lt; 90mmHg, or reperfusion before the SBP lt; 90mmHg reperfusion further reduce more than 25% in the non-pacing reperfusion hypotension group. General clinical features observed in patients with coronary lesion characteristics, reperfusion before heart rate, blood pressure levels before and after reperfusion, the occurrence of malignant ventricular arrhythmias after reperfusion; reperfusion hypotension drug use as well as the duration of remission; during hospitalization malignant ventricular arrhythmia occurs circumstances. Results 1. Temporary pacing malignant ventricular arrhythmias protective pacing and non-pacing group, required pacing group was statistically significant (P lt; 0.01), protective pacing ventricular tachycardia room The chatter of the high incidence of non-pacing group (17.78% vs. 3.16%, P lt; 0.05). Low heart rate group with non-pacing, pacing protection low heart rate group VT higher incidence of ventricular fibrillation, (11.11% vs. 6.06%, P = 0.521) but the difference between the two groups did not reach significant. Compared with the non-pacing normal heart rate group, conservation group ventricular tachycardia pacing normal heart rate incidence of ventricular fibrillation was significantly higher (22.22% vs. 2.40%, P lt; 0.01). Logistic regression analysis results are shown: RR = exp (-3.430 1.748x1 0.041x2), protective pacing occurrence of ventricular tachycardia ventricular fibrillation risk factors (P lt; 0.01), the protection of the occurrence of ventricular tachycardia pacing ventricular fibrillation risk than non-pacing 5.74 times higher. Protection pacing on reperfusion reaction affecting protective pacing reperfusion incidence of hypotension and non-pacing group tended to increase (40.00% vs. 30.38%, P = 0.224); protective pacing group The incidence of ventricular fibrillation after reperfusion ventricular tachycardia than non-pacing group also tended to increase (6.67% vs 2.53%, P = 0.180). Before reperfusion SBP and non-protective pacing pacing no significant difference, but the pacing group SBP protective after reperfusion were significantly lower (P lt; 0.05). Compared with non-pacing the normal heart rate group, no significant differences before reperfusion SBP, but protective after reperfusion pacing the normal heart rate of SBP were significantly lower (P lt; 0.05). Compare before reperfusion, systolic and diastolic blood pressure were decreased in each group after reperfusion (P lt; 0.01). 3. Protective pacing on the reperfusion hypotension ease the time and drug use in non-pacing majority of proportion with atropine reperfusion hypotension group, 56.41%; protective pacing reperfusion hypotension group mostly with catecholamines (57.14%); the atropine catecholamines associated with about 30% of the proportion of patients in both groups. The two groups need to use medication proportion of patients (77.78% vs.81.25%) no significant difference. No significant difference in two groups hypotension recovery time after treatment, the majority of patients with blood pressure returned to normal within 5 minutes, a very small number of patients with blood pressure recovery time of over 10 minutes. Conclusion temporary pacing with increased risk of acute inferior wall myocardial infarction patients with emergency PCI malignant ventricular arrhythmias occurred. Protective temporary pacing no significant protective effect on reperfusion reaction: ① prevention and reduction of reperfusion hypotension role; ② no prevention or reduction of reperfusion of malignant ventricular arrhythmias role. The temporary pacing protective not reduce reperfusion hypotension alleviate the role of time and drug use.

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CLC: > Medicine, health > Internal Medicine > Heart, blood vessels ( circulatory ) disease > Heart disease > Myocardial diseases > Myocardial infarction
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