Locations of coronary artery lesions in patients with severe conduction disturbance
Murat Yesil1, Erdinc Arikan, Nursen Postaci
1Department of Cardiology, Ataturk Teaching Hospital, Izmir, Turkey.
Insights
Severe conduction disturbances in patients needing pacemakers are linked to specific coronary artery lesion locations. This pattern differs significantly from controls, suggesting a unique coronary pathology in these patients.
Area of Science:
- Cardiology
- Electrophysiology
- Interventional Cardiology
Background:
- The relationship between cardiac conduction abnormalities and coronary artery disease (CAD) is not fully understood.
- Patients requiring permanent pacemakers often have underlying cardiac conditions that may involve coronary pathology.
Purpose of the Study:
- To investigate the specific locations of coronary artery lesions in patients with severe conduction disturbances who require permanent pacemaker implantation.
- To compare the coronary lesion distribution in this patient group with a control group having significant CAD but no conduction issues.
Main Methods:
- Coronary angiography was performed on 203 patients with severe conduction disturbances prior to pacemaker implantation.
- Coronary lesions were classified into four types based on their involvement of septal branches and the artery of the atrioventricular node (AVN).
- A control group of 62 age-matched subjects with significant coronary artery lesions (>50%) but no conduction disturbance was included for comparison.
Main Results:
- Of the 203 patients, 30% had significant coronary stenoses (>50%).
- Among patients with significant CAD, Type II lesions (involving septal perforators of the LAD but not RCA) were most prevalent (38.7%), followed by Type IV (combination of Type II and III) (35%).
- This distribution was significantly different from the control group, where Type III and Type I lesions were most common.
Conclusions:
- Patients with severe conduction disturbances requiring pacemakers exhibit a distinct pattern of coronary artery lesions.
- This pattern often involves proximal Left Anterior Descending (LAD) branches or a combination with Right Coronary Artery (RCA) disease, potentially affecting blood supply to the sinoatrial (SAN) and AV nodes.
- These findings highlight a specific coronary pathology associated with conduction system disease.
Abstract:
The relation between conduction disturbances and coronary pathology is often uncertain. The aim of this study was to examine the location of coronary lesions in patients who have an indication for a permanent pacemaker. Between 2001 and 2006, 203 consecutive patients (121 men (59%), mean age, 65 +/- 10) who had severe conduction disturbance underwent coronary angiography before pacemaker implantation. Third degree AV block was present in 172 (84%), sick sinus syndrome in 21 (11%), and Mobitz II, second degree AV block in 10 (5%). The coronary angiographic study included stenosis severity and classification of pathological anatomy. Sixty-two age-matched subjects with coronary artery lesions > 50% but without conduction disturbance made up the control group. The locations of coronary lesions were classified as follows: Type I: Lesions not related to septal branches or AV node (AVN) artery; Type II: Lesions involving the septal perforators of LAD but not RCA; Type III: Lesions compromising blood supply to SAN or AVN (No LAD septal involvement); and Type IV: Combination of Type II and Type III. Of 203 patients, insignificant coronary pathology was found in 141 (70%- group X). Sixty-two patients (30%) had coronary stenoses > 50% (group I) and Type II coronary anatomy was the most prevalent (n = 24, 38.7%), followed by Type IV (n = 22, 35%). Type III was found in 10 (16%) and Type I in 6 (9.6%). This distribution of CAD was significantly different from the control group in whom the most prevalent lesion locations were Type III and I (39% and 31%, respectively) (P < 0.05). Patients with severe conduction disturbances tend to have a specific coronary lesion distribution that involves either proximal LAD branches or a combination of this with significant RCA disease, compromising supply to sinoatrial or AV nodes.
More Related Videos
08:42Cox-Maze IV Procedure Concomitant with Valvular Surgery In Situs Inversus Dextrocardia: A Single-Center Experience in China
Published on: February 11, 2022
18:11A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
Published on: December 28, 2012
Related Concept Videos
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Acute Coronary Syndrome I: Introduction
01:30Coronary Artery Disease III: Clinical Manifestations
01:21Coronary Circulation
Coronary circulation begins at the base of the aorta, where two main arteries arise—the left and right coronary arteries. These arteries encircle the heart in the coronary sulcus and supply the...
01:23Mitral Stenosis II: Clinical features and Diagnostic Tests