Related Experiment Video
Updated: Jun 29, 2026
Establishing a Swine Model of Post-myocardial Infarction Heart Failure for Stem Cell Treatment
Published on: May 25, 2020
Should we revascularize before implanting a pacemaker?
Murat Yesil1, Serdar Bayata, Erdinc Arikan
1Department of Cardiology, Ataturk Teaching Hospital, Izmir, Turkey.
Insights
Coronary revascularization has minimal impact on restoring normal heart rhythm in patients with severe coronary artery disease and complete atrioventricular block. Pacemakers are recommended before revascularization for these patients.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- The impact of coronary revascularization on severe conduction disturbances remains unclear.
- Investigating recovery of sinus rhythm in patients with coronary artery disease and atrioventricular block is crucial.
Purpose of the Study:
- To determine if revascularization can restore sinus rhythm in patients with significant coronary artery disease and complete atrioventricular block (AVB).
Main Methods:
- Fifty-three patients with third-degree AVB and coronary artery disease (excluding acute coronary syndromes) were enrolled.
- Patients received a dual-chamber pacemaker; 16 were treated medically, and 37 underwent revascularization (CABG or PCI).
- Follow-up was 36 months with regular ECG evaluations.
Main Results:
- In the medically treated group, 19% regained normal sinus rhythm; 81% remained in AVB.
- In the revascularized group, 27% regained normal sinus rhythm; 73% remained in AVB.
- No significant difference in pacemaker need between groups.
Conclusions:
- Coronary revascularization shows little effect on restoring normal atrioventricular (AV) conduction in patients with concomitant severe conduction disturbances and coronary disease.
- Pacemaker implantation is advisable before considering revascularization in these patients.
Background:
The effect of coronary revascularization on disappearance of the severe conduction disturbances is still unclear.
Hypothesis:
We sought to determine whether revascularization may induce recovery of sinus rhythm in patients with significant coronary artery disease and complete atrioventricular block (AVB).
Methods:
Fifty-three patients who had third-degree AVB and significant coronary artery disease were enrolled. Patients with acute coronary syndromes were excluded. Thirty-three (62%) patients were men and the mean age was 65 +/- 10 y. All patients received a permanent dual-mode, dual-pacing, dual-sensing (DDD) pacemaker. Coronary disease was treated medically in 16 (30%) patients due to patient preference or ineligibility. Thirty-seven (70%) patients underwent a revascularization procedure (coronary artery bypass grafting [CABG]: 16, percutaneous coronary intervention [PCI]: 21 pts). Mean follow-up was 36 +/- 6 mo and patients were evaluated every 3 mo according to their resting electrocardiograms (ECGs) at each visit.
Results:
In the medically treated group, 13 (81%) patients still had third-degree AVBs at the end of the follow-up period, while 3 (19%) patients returned to normal sinus rhythm. On the other hand, 27 out of 37 patients (73%) who were revascularized were still in complete AVB, and 10 patients from this group (27%) had returned to normal sinus rhythm. There was no statistically significant difference between the revascularized and medically treated groups in terms of need for a pacemaker.
Conclusions:
Patients who have concomitant severe conduction disturbances and significant coronary disease may well receive a pacemaker before a revascularization procedure. Our data shows that coronary revascularization has little, if any, impact on returning to normal AV conduction.
