| Objective This study retrospectively analyzed the multiple clinical data of the inpatients with acute inferior wall myocardiac infarction who underwent emergency percutaneous coronary intervention (PCI). The effects of temporary cardiac pacing on malignant ventricular arrhythmia (ventricular fibrillation and ventricular tachycardia with unstable hemodynamics), the post-reperfusion reaction, the remission time of post- reperfusion hypotension, and the performance of medication administration were evaluated.Methods Of the 219 inpatients with acute inferior wall myocardiac infarction who underwent successful emergency PCI in Dalian Zhongxin Hospital and Dalian Friendship Hospital in 2000-2007, 61 patients underwent temporary cardiac pacing (56 cases underwent pre-reperfusion cardiac pacing; 5 cases underwent post- reperfusion cardiac pacing); 158 patients did not undergo temporary cardiac pacing. The group of patients (45 cases) with HR (heart rate)≥50 beats / min (including the patients with HR≥50 beats / min after the administration of atropine) who underwent pre-reperfusion cardiac pacing were categorized as preventive temporary cardiac pacing group. The group of patients (16 cases) with HR < 50 beats / min who underwent pre-reperfusion cardiac pacing, as well as the patients who underwent post-reperfusion cardiac pacing due to slow HR ( less than 50 beats / min) were categorized as essential cardiac pacing group. The preventive cardiac pacing group was furtherly divided into brachycardia group and normal cardia group according to the pre-reperfusion HR. The preventive temporary cardiac pacing patients with post-reperfusion SBP (systematic blood pressure) less than 90 mmHg, and the patients with pre- reperfusion SBP less than 90 mmHg followed by more than 25% reduction in post-reperfusion SBP, were categorized as preventive cardiac pacing post-reperfusion hypotension group. The group of patients who did not undergo cardiac pacing were categorized as non-cardiac pacing group. The non-cardiac pacing group was furtherly divided into brachycardia group and normal cardia group according to the pre-reperfusion HR. The non-cardiac pacing patients with post-reperfusion SBP less than 90 mmHg; and the patients with pre- reperfusion SBP less than 90 mmHg followed by more than 25% reduction in post-reperfusion SBP, were categorized as non-cardiac pacing post-reperfusion hypotension group. We observed the patients for general clinical manifestations, coronary artery pathologic features, HR before the reperfusion, BP before and after the reperfusion, the occurrence of malignant ventricular arrhythmia during cardiac pacing. Results1 The effects of preventive cardiac pacing on malignant ventricular arrhythmia Compare the preventive cardiac pacing group, the non-cardiac pacing group, and the essential cardiac pacing group, the effect of temporary cardiac pacing on malignant ventricular arrhythmia was of statistics significance (P<0.01). The occurrence rate of ventricular tachycardia and ventricular fibrillation was higher in the preventive cardiac pacing group than the non-cardiac pacing group (17.78% vs. 3.16%, P<0.05). There was an increase trend in the occurrence rate of ventricular tachycardia and ventricular fibrillation in the preventive cardiac pacing brachycardia group than the non-cardiac pacing brachycaria group (11.11% vs. 6.06%,P=0.521), but there was no significant difference. There was a significance increase in the occurrence rate of ventricular tachycardia and ventricular fibrillation in the preventive cardiac pacing normal cardia group than the non-cardiac pacing normal cardia group (22.22% vs. 2.40%, P<0.01). The Logistic regression analysis revealed that RR= exp (-3.430 + 1.748x1 + 0.041x2). The preventive cardiac pacing was a risk factor of ventricular tachycardia and ventricular fibrillation (P<0.01). The risk was 5.74 times higher in the preventive cardiac pacing group than the non-cardiac pacing group. 2 The effects of preventive cardiac pacing on reperfusion reaction The occurrence rate of hypotension after reperfusion was higher in the preventive cardiac pacing group compared to the non-cardiac pacing group (40.00% vs.30.38%, P=0.224). The preventive cardiac pacing group was higher in reperfusion ventricular tachycardia and ventricular fibrillation (6.67% vs.2.53%,P=0.180). SBP before reperfusion was not different in two group(P>0.05), but there was a dramatic drop in term of preventive cardiac pacing group compared to the non-cardiac pacing group after reperfusion (P<0.05). There was no obvious difference in term of pre-reperfusion SBP between the preventive cardiac pacing group with normal heart rate and the non-cardiac pacing group with normal heart rate; but there was significant drop in term of post-reperfusion SBP (P<0.05)in the preventive cardiac pacing group. SBP and DBP (diastolic blood pressure)after reperfusion were lower than the pre-reperfusion SBP and DBP in all groups.3 The effect of protective pacing on reperfusion hypotension recover time and medication In non-pacing reperfusion hypotension group, single atropine gets the most proportion, as 56.41%. However in protective reperfusion hypotension group single catecholamine is the most, as 57.14%. The proportion of patients treated with atropine and catecholamine in both groups is the same, as about 30%. There is no marked difference between the proportion of patient needing medicine therapy(77.78% vs.81.25%). There is also no marked difference between the two groups in hypotension recover time, as most patients'blood pressure recovered within 5 minutes after medication. While few patients'blood pressure recover time more than 10 minutes.Conclusions Temporary cardiac pacing may increase the risk of malignant ventricular arrhythmia in patients with acute inferior wall MI undergoing emergency PCI. The preventive temporary cardiac pacing has no obvious effect in preventing post reperfusion reaction. It can not prevent or decrease the risk of post reperfusion hypotension; it can not prevent or decrease the occurrence of malignant ventricular arrhythmia. Also, preventive temporary cardiac pacing has no effect on decreasing the remission time of post- reperfusion hypotension; it has not effect on the performance of medication administration.
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