Improvement of Cerebral Blood Flow and Cognitive Function following Pacemaker Implantation in Patients with Bradycardia

Abstract

We investigated the effects of pacemaker implantation on cerebral blood flow and cognitive function in 14 severely bra-dycardic patients (mean age 75.2 years). Cerebral blood flow and verbal intelligence improved after the pacemaker implantation. Systolic and mean arterial blood pressure was significantly reduced after the implantation. Changes in cerebral blood flow significantly correlated with changes in heart rate in polynomial regression analysis, but not with changes in cardiac output. Before the implantation, verbal cognitive function was lower in bradycardic patients than in age-matched control subjects, and brain CT showed significant advanced atrophy in these patients. However, verbal cognitive function was also improved after the implantation. Pacemaker implantation in the severe bradycardic elderly should be beneficial not only for cardiac function but also for brain function. We concluded that these results suggest that heart rate is one of the important factors in the regulation of cerebral circulation in patients with severe bradycardia. Pacemaker implantation in the elderly improved quality of life and may prevent mental deterioration.

Cognitive function and left ventricular assist device implantation

“…It has been reported that impaired cognitive function in patients with heart failure improves significantly following cardiac transplantation and pacemaker implantation in bradycardic individuals. 31,32 A previous study of neurocognitive function in patients undergoing LVAD included the HeartMate II clinical trial participants, which showed stable or improved cognitive function after 24 months of follow up. 20 However, among other limitations, this study did not assess cognitive function prior to implantation.…”

Neuroimaging and Correlates of Cognitive Function among Patients with Heart Failure

“…Reversibility of cognitive impairment after medical treatment or heart transplantation has been suggested by some authors [37,38] . In view of our findings, it could be suggested that this is more likely to occur in the early stages of heart disease before the brain has suffered structural damage.…”

Chronic Ischemia and Neurocognition

“…Pacemaker implantation is another approach by which cognition can be improved potentially in patients who have heart dysfunction [43,44]. Pacemakers improve heart rate, resulting in increased CBF levels [43].…”