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Percutaneous coronary intervention delays pacemaker implantation in coronary artery disease patients with established
Lihua Zhong1, Yanhui Gao, Hongyuan Xia
1Department of Cardiology, The Fourth Clinical Hospital of Harbin Medical University, Harbin, China.
Insights
Percutaneous coronary intervention (PCI) may delay the need for pacemakers in coronary artery disease patients with asymptomatic bradyarrhythmias. This study suggests PCI offers a potential benefit by postponing pacemaker implantation.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Pacemakers are standard for bradyarrhythmias.
- The impact of percutaneous coronary intervention (PCI) on patients with both coronary artery disease (CAD) and bradyarrhythmias is unclear.
Purpose of the Study:
- To investigate the effect of PCI on the need for pacemaker implantation in patients with CAD and asymptomatic bradyarrhythmias.
Main Methods:
- A study compared 42 patients with CAD and asymptomatic bradyarrhythmias who underwent PCI to 41 similar patients who did not receive PCI.
- Patients were monitored for an average of 3.3 years for pacemaker implantation and symptom development.
Main Results:
- PCI patients showed significantly lower rates of pacemaker implantation annually compared to the control group.
- While some patients in both groups experienced worsening bradyarrhythmias, symptoms requiring pacemakers were delayed in the PCI group.
Conclusions:
- Percutaneous coronary intervention (PCI) appears to delay the need for pacemaker implantation in patients with coronary artery disease and asymptomatic bradyarrhythmias.
Background:
Pacemakers have long been used to assist the heart under pathological conditions, and they are the first choice in the treatment of systematic bradyarrhythmias. However, the effect of percutaneous coronary intervention (PCI) in patients with coronary artery disease as well as bradyarrhythmias remains unknown.
Methods:
In the present study, 42 patients with chest pain and/or abnormal stress test results were surveyed. Before coronary angiography, patients underwent complete examination, including a 24 h dynamic electrocardiogram, which was used to diagnose bradyarrhythmias that were not suitable for pacemaker implantation due to a lack of arrhythmia-related symptoms. All patients underwent PCI but did not undergo pacemaker implantation. Forty-one patients with chest pain and/or abnormal stress test results, as well as symptom-free bradyarrhythmias, were selected as the control group. All of the patients in the control group were committed to treatments without PCI.
Results:
During a mean (±SD) of 3.3±0.5 years of follow-up (range 2.5 to 4.5 years), 24 of 42 patients who received PCI underwent pacemaker implantation for arrhythmia-related symptoms, eight were shown by Holter monitoring to have worsened but still exhibited no symptoms, and the remainder did not show any changes according to the examinations performed. In the control group, 31 patients underwent pacemaker implantation for arrhythmia-related symptoms, eight were shown by Holter monitoring to have worsened but still exhibited no symptoms, and two did not show any changes according to the examinations performed. Nevertheless, the rates of pacemaker implantation each year (from the first to the third year) between the two groups were 7.1% versus 39.0% (P=0.001); 33.3% versus 63.4% (P=0.006); and 57.1% versus 75.6%, (P=0.075), respectively.
Conclusions:
The present study found that PCI delayed the demand for pacemaker implantation among coronary artery disease patients.
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