Treatment of peri-myocardial infarction conduction abnormalities

ECG: electrocardiogram; AV: atrioventricular; MI: myocardial infarction; PPM: permanent pacemaker.
* Transcutaneous pacing is frequently the quickest way to provide temporary cardiac pacing, but is unreliable for extended periods of treatment and uncomfortable for the patient. While transcutaneous pacing may be initially successful in stabilizing the patient, central venous access should be established and transvenous pacing provided in the vast majority of patients requiring temporary cardiac pacing.
¶ The initial dose of atropine is 0.5 mg IV. This dose may be repeated every three to five minutes to a total dose of 3 mg. If the patient does not respond promptly and/or clinically deteriorates, proceed directly to temporary pacing.
Δ The typical aminophylline dose is 250 mg IV bolus. In patients with a prior heart transplant, a higher weight-based dose is preferred (6 mg/kg IV mixed in 100 to 200 mL of IV fluid adminstered over 20 to 30 minutes).
◊ Refer to UpToDate content on management of acute MI.
§ In general, a waiting period of several days should be employed to determine potential reversibility of AV block, particularly in patients with acute inferior MI. If no reversible causes are present, definitive treatment involves PPM placement in most patients.