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Coronary angiographic characteristics of patients with permanent artificial pacemakers
M Mosseri1, T Izak, S Rosenheck
1Cardiology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel. mosseri@cc.huji.ac.il
Insights
Severe cardiac conduction disturbances requiring pacemakers are linked to specific coronary artery disease patterns. This includes compromised blood flow to septal branches and right coronary artery lesions, not just diffuse atherosclerosis.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Electrophysiology
Background:
- The etiology of severe cardiac conduction disturbances is frequently unclear.
- This study investigated the role of coronary atherosclerotic disease in patients with permanent pacemakers.
Purpose of the Study:
- To determine the extent of coronary atherosclerotic disease responsible for conduction disturbances in patients with permanent pacemakers.
- To identify specific coronary artery pathologies associated with severe conduction abnormalities.
Main Methods:
- Coronary arteriography was performed on 43 patients with permanent pacemakers and 36 matched controls.
- Analysis included diameter, stenosis severity, flow assessment, and pathological anatomy, focusing on conduction system territories.
- Specific attention was paid to lesions in the septal branches and right coronary artery.
Main Results:
- 27 of 43 pacemaker patients had ischemic heart disease.
- Conduction disturbances included infranodal (28), sinus nodal (6), AV nodal (4), and complete AV block (5).
- Pacemaker patients showed significantly different coronary anatomy (compromised septal branches and right coronary artery) compared to controls.
Conclusions:
- Specific coronary artery anatomy, particularly involving septal branches and the right coronary artery, is associated with severe conduction disturbances requiring pacemakers.
- The location of coronary lesions, rather than diffuse atherosclerosis, appears critical in causing these conduction abnormalities.
Background:
The cause of severe cardiac conduction disturbances is often uncertain. The aim of this study was to examine a group of patients with permanent pacemakers who underwent coronary arteriography to determine the extent of coronary atherosclerotic disease that might be responsible for the conduction disturbances.
Methods And Results:
Forty-three consecutive patients with a permanent pacemaker and 36 matched control patients were investigated. The coronary angiographic study included measurement of diameter and stenosis severity, qualitative assessment of flow, and classification of pathological anatomy, particularly the blood supply to territories supplying the different segments of the conduction system. Among 43 patients with a permanent pacemaker, 27 had ischemic heart disease (17 after coronary artery bypass graft surgery). The conduction disturbance was infranodal in 28 patients, sinus nodal in 6, AV nodal in 4, and complete AV block of unspecified origin in 5. Patients with permanent pacemakers had a coronary artery pathology compromising blood flow to the septal branches and the right coronary artery (type IV anatomy). This pattern was significantly different from the matched control patients, in whom the most prevalent coronary anatomy was the combination of right coronary artery with distal left anterior descending artery (not involving the septal branches) lesions (P=.007).
Conclusions:
Patients with coronary artery disease and severe conduction disturbances that require implantation of permanent pacemakers are more likely to have a specific pathological coronary anatomy that combines a compromised blood flow to the septal branches of the left anterior descending artery with right coronary artery lesions. The location of lesions in the coronary tree rather than severe diffuse atherosclerosis appears to be responsible for the conduction disturbances.