Atropine-induced multilevel block in acute inferior myocardial infarction. A possible indication for prophylactic pacing

Agustin Castellanos, H. G. Garcia, J. J. Rozanski, L. Zaman, K. Pefkaros, Robert J Myerburg

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

The degree of A-V block increased after intravenous administration of atropine in 10 nondigitalized patients with acute inferior myocardial infarction who had narrow QRS complexes during period of 1:1 A-V conduction. Short episodes of 3:1, 4:1 and 5:1 A-V block were seen to emerge: (a) in 6 patients, directly from Wenckebach periods; (b) in 3 patients, from alternating Wenckebach periods; and (c) in 1 patient, from a 3:2 Wenckebach period which led to a short-lived alternating Wenckebach period. Apparently, the predominance of the chronotropic effects on the sinus node over the dromotropic effects on the A-V node led to a tachycardia-dependent (more ischemic than vagal) process, exposing or producing multi- (two, three of four) level block involving the A-V node (and perhaps the His bundle). Subsequently, therapeutic pacing was instituted in 9/10 patients because they developed spontaneous symptomatic advanced A-V block. Therefore, it is possible that the early effect of atropine identified a narrowly-defined subset of patients in whom prophylactic pacing may be indicated. However, more studies are necessary to corroborate assumptions.

Original languageEnglish
Pages (from-to)528-537
Number of pages10
JournalPACE - Pacing and Clinical Electrophysiology
Volume4
Issue number5
StatePublished - Dec 1 1981

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Inferior Wall Myocardial Infarction
Atropine
Atrioventricular Node
Bundle of His
Sinoatrial Node
Tachycardia
Intravenous Administration

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Atropine-induced multilevel block in acute inferior myocardial infarction. A possible indication for prophylactic pacing. / Castellanos, Agustin; Garcia, H. G.; Rozanski, J. J.; Zaman, L.; Pefkaros, K.; Myerburg, Robert J.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 4, No. 5, 01.12.1981, p. 528-537.

Research output: Contribution to journalArticle

Castellanos, Agustin ; Garcia, H. G. ; Rozanski, J. J. ; Zaman, L. ; Pefkaros, K. ; Myerburg, Robert J. / Atropine-induced multilevel block in acute inferior myocardial infarction. A possible indication for prophylactic pacing. In: PACE - Pacing and Clinical Electrophysiology. 1981 ; Vol. 4, No. 5. pp. 528-537.
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