Locations of Coronary Artery Lesions in Patients With Severe Conduction Disturbance

Abstract

SUMMARYThe 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. (Int Heart J 2008; 49: 525-531)

Reversibility of Atrioventricular Block According to Coronary Artery Disease: Results of a Retrospective Study

“…2-6)14) In the present study, type IV was the most common type of coronary pathology and type II was the second most common type in IB group; type I anatomy observed in 9.1% of patients with CAD, type II in 22.7%, type III in 15.9%, and type IV in 52.3%. In the study by Yesil et al14) the distribution of coronary pathology was 9.6% type I, 38.7% type II, 16.0% type III, and 35.0% type IV. Tandoğan et al3) studied 78 patients who had pacemaker implantation and angiographically proven CAD, and the distribution was 19% type I, 24% type II, 11% type III, and 45% type IV.…”

“…Mosseri et al2) reported that a compromised blood flow of the septal branch and the RCA were associated with conduction disturbances. Tandoğan et al,3) Yesil et al,14) and Wei et al4) reported similar results; stenoses of septal branch from LAD or RCA are associated with AVB. However, revascularization of the stenosed coronary artery could not reverse conduction disturbances 5)6)…”

Relation of QRS Width in Healthy Persons to Risk of Future Permanent Pacemaker Implantation

“…Although it is possible that the association between QRS duration and incident pacemaker events is due in part to underlying coronary artery disease, with lesions that may directly or indirectly compromise blood supply to the sinoatrial or atrioventricular nodes,21 our findings remained robust even after accounting for incident as well as prior myocardial infarction. Furthermore, individuals with prevalent myocardial infarction or heart failure comprised only 4% of our generally healthy, ambulatory cohort.…”

Anomalous right coronary artery originating from the left anterior descending artery: Case report and review of the literature

“…Several previous retrospective case control studies of selected patients with coronary artery disease who required pacemaker implantation have suggested a correlation between a specific distribution of atherosclerosis and the need for a permanent pacemaker. Cases were more likely than controls, who did not need pacemakers, to have atherosclerosis involving both the septal arteries and RCA [56][57][58]. In this case, the location of the stenosis within the proximal and mid LAD in the segment involving both the septal perforators and RCA origin would likely be seen to fit this criteria.…”