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Patient
63-year-old man with multiple risk factors (tobacco use, hypertension, NIDD), constrictive chest pain since 1 hour; call to SAMU emergency services; ECG recorded on arrival at the emergency room;
Trace
Sinus rhythm with ST segment elevation in the inferior territory with reciprocity in leads I, aVL, V2 and V3;
Trace
Second tracing obtained a few minutes later; atrioventricular dissociation with persistence of ST segment elevation; complete AV block due to inferior infarction;
Exergue
Depending on the location of the infarction (anterior or inferior/posterior), the anatomical and evolving morphological characteristics of the AV block are opposite. The prognosis is often highly altered in the setting of a post-infarction anterior AV block, with very high mortality. Conversely, the conduction disorder is most often spontaneously resolved within a few days in the setting of an inferior infarction. The indications for definitive pacemaker implantation are therefore very rare.
The incidence of complete atrioventricular block in the setting of an acute infarction has considerably decreased since the use of reperfusion techniques (thrombolysis or emergency angioplasty) although remains nonetheless non-negligible (approximately 3 to 5%).