Prevalence and characterization of coronary artery disease in patients with symptomatic bradyarrhythmias requiring pacemaker implantation

Alai, Mohammad S.; Beig, Jahangir Rashid; Kumar, Sanjay; Yaqoob, Irfan; Hafeez, Imran; Lone, Ajaz Ahmad; Dar, Mohammad Iqbal; Rather, Hilal

doi:10.1016/j.ihj.2016.06.013

Cited by 15 publications

(17 citation statements)

References 25 publications

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“…It can be said that such patients should undergo coronary monitoring before undergoing pacemaker surgery. Simultaneous CAD treatment is likely to improve the long-term prognosis of these patients [19]. The findings of the mentioned study on coronary artery disease are more than our study.…”

Section: Discussionmentioning

confidence: 54%

Investigating the Manifestation of Coronary Artery Disease and Determining the Role of Effective Factors in the Need for Pacemaker Insertion in These Patients

Tayyebi

Sani

Moghadam

et al. 2019

Open Access Maced J Med Sci

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BACKGROUND: Many patients who are candidates for a pacemaker are also at the same time risk factors for coronary artery disease such as high blood pressure, hypertension, diabetes, and hyperlipidemia, and therefore the probability of having coronary artery disease is significant. Effective diagnostic measures can be taken to prove the factors affecting the incidence of CAD in patients undergoing pacemakers at high-risk, including angiography. Therefore, it can prevent complications during and after pacemaker implantation, which leads to an increase in the quality of treatment in patients requiring pacemaker implantation. AIM: Therefore, the purpose of this study was to determine the predictive factors of significant coronary artery disease in patients with pacemaker implantation to identify patients in need of coronary angiography at the time of pacemaker implantation. METHODS: This retrospective study was carried out to examine the patients' files that were placed at the heart of Imam Reza Hospital during the period between March 2017 and September 2017. Demographic data, risk factors, echocardiography findings, and angiography, were collected and then recorded using a checklist. Statistical analysis was performed using SPSS software version 22 and Chi-square, and Mann-Whitney tests were used for determining significates variables. RESULTS: A group of 102 patients who had undergone a permanent cardiac pacemaker insertion due to an atrioventricular (AV) Block were included in the study, and also coronary anatomy was determined coronary angiography. Based on the results, 13.7% of patients with cardiac pacemaker had obstructive coronary artery disease (stenosis > 70%). Factors affecting coronary artery stenosis on angiography include gender, chest pain, history of myocardial infarction, angioplasty, diabetes, smoking, history of aspirin intake, calcium blocker and Plavix, high hematocrit, ST elevation and ST depression in the ECG, and severe mitral regurgitation. CONCLUSION: It seems that in most patients requiring permanent pacemaker insertion because of the atrioventricular (AV) Block, angiography does not change the patient's fate, and so can be ignored. However, in patients who have several risk factors from the listed above, coronary angiography is recommended during admission.

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Section: Discussionmentioning

confidence: 54%

Investigating the Manifestation of Coronary Artery Disease and Determining the Role of Effective Factors in the Need for Pacemaker Insertion in These Patients

Tayyebi

Sani

Moghadam

et al. 2019

Open Access Maced J Med Sci

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“…Brueck et al [6] in an angiographic study of 507 patients requiring pacemaker implantation and at least one atherosclerotic risk factor, found a remarkable 71% incidence of CAD. Alai et al [2] revealed an overall 45% incidence of CAD and 29% incidence of significant CAD in these patients. Our study revealed a prevalence rate of 19.4% of CAD in patients who underwent PPI during 2011-2015.…”

Section: Discussionmentioning

confidence: 93%

“…Bradycardia is a common clinical phenomenon and can be defined as heart rate below 60 bpm. It may also be associated with various rhythmic disorders such as sinus nodal disease (SND) and atrioventricular (AV) blocks [2]. Patients with regular or occasional conduction disturbance who experience symptoms such as fatigue, presyncope or syncope require permanent pacemaker implantation (PPI) [3].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Coronary Artery Disease and Its Risk Factors in Patients Undergoing Permanent Pacemaker Implantation

Jayaram

Iype

Karkera

et al. 2019

ijcp

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Introduction: Some pacemaker implanted patients have an atherosclerotic disease which promotes conduction system ischemia and conduction disturbances. The aim of this study was to determine prevalence of coronary artery disease (CAD) and its risk factors in patients undergoing permanent pacemaker implantation (PPI). Methods: This prospective, single-center hospital based study examined patients older than 40 years who required PPI. Presence of atherosclerotic risk factors and CAD was examined. Results: Of 258 patients undergoing PPI, CAD was present in 50 (19.37 %) patients. CAD was more common among middle age and elderly patients (P = 0.03). Patients older than or equal 76.5 years had specificity of 78.8% for an association with CAD. Multivariate analysis showed that age (odds ratio: 1.042; 95% confidence interval: 1.009-1.075; P = 0.01) and diabetes (odds ratio: 3.437; 95% confidence interval: 1.618-7.303; P = 0.001) had a statistically significant association with CAD. Of 169 patients with involvement of the atrioventricular (AV) node, 28 (16.6 %) had associated left anterior descending artery (LAD) involvement with P = 0.01, suggesting an association between LAD disease and chronic degenerative changes in the AV node. Conclusion: CAD was present in 19.4% of patients undergoing PPI. Age and diabetes had a strong association with CAD. LAD stenosis was significantly more prevalent in AV nodal/ infra-hisian disease compared with sinus nodal disease.

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“…Few small studies have investigated association between conduction disturbance & coronary atherosclerosis. 2 , 3 , 4 , 5 , 6 These studies showed 15–70% association of chronic coronary artery disease in chronic conduction disorders. 7 , 8 , 9 , 10 Coexistence of CAD with symptomatic bradycardia has major effects on prognosis & long term plan of care in form of either medication or revascularization.…”

Section: Introductionmentioning

confidence: 95%

“… 1 These histopathological changes are nonspecific & cannot explain the underlying disorder as these changes can be seen in many pathological conditions like hypertension, congenital heart diseases, myocardial diseases or coronary atherosclerosis. 2 …”

Section: Introductionmentioning

confidence: 99%

Coexistent coronary artery disease in Indian patients undergoing permanent pacemaker implantation (PPI) for symptomatic bradyarrhythmia

Vyas

Meghnathi

Joshi

et al. 2021

Indian Heart Journal

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Background The cause-effect of conduction disturbance in chronic lesion of coronary arteries is complicated. This study was designed to evaluate coexistent CAD in patients with symptomatic bradyarrhythmia to find common anatomic basis for conduction disturbances and its relationship to conventional coronary risk factors. Methods In this prospective observational study, 929 patients who admitted for symptomatic bradyarrhythmia requiring permanent pacemaker implantation were included. All included patients underwent coronary angiography and were divided into groups based on angiographic findings. Association between conduction disturbances and these groups were analyzed. Results A total of 929 patients with mean age of 63.1 years were included in our study. We found age ≥50 years, male sex, presence of diabetes and hypertension as statistically significant predictors of abnormal coronary angiography. Obstructive CAD (≥50% stenosis) was found in 34.4% patients. Prevalence of single vessel disease, double vessel disease and triple vessel disease was 15.3%, 10.2% and 8.9% respectively. Severe coronary obstruction (≥90% obstruction) was found in 16.25% patients. Revascularization was advised in three fourth of cases of obstructive CAD. Approximately two third of patients didn’t have significant obstruction in coronaries supplying the conduction system. Type 4 was the commonest anatomy in obstructive CAD. SA Nodal artery was found more diseased in patients of SSS with p value of 0.01. Conclusion Obstructive CAD was found in one third of patients undergoing PPI. Age ≥50 years, male sex, diabetes and hypertension were found significantly correlated with presence of CAD and may act as important markers for the judgment of further coronary evaluation.

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Prevalence and characterization of coronary artery disease in patients with symptomatic bradyarrhythmias requiring pacemaker implantation

Cited by 15 publications

References 25 publications

Investigating the Manifestation of Coronary Artery Disease and Determining the Role of Effective Factors in the Need for Pacemaker Insertion in These Patients

Investigating the Manifestation of Coronary Artery Disease and Determining the Role of Effective Factors in the Need for Pacemaker Insertion in These Patients

Prevalence of Coronary Artery Disease and Its Risk Factors in Patients Undergoing Permanent Pacemaker Implantation

Coexistent coronary artery disease in Indian patients undergoing permanent pacemaker implantation (PPI) for symptomatic bradyarrhythmia

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