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

Abstract

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.

Development and Validation of a Nomogram for Predicting the Severity of Coronary Artery Disease Based on Cardiopulmonary Exercise Testing

“… 28 Additionally, hypertension and hyperglycemia are well-established risk factors for adverse cardiovascular events. 29 – 31 …”

Resolution of Marked Bradycardia Following Angioplasty

“…However, in the study by Brueck et al, a direct causal link between the requirement for a pacemaker and CAD could not be definitively established based on the study results [ 15 ]. In the study by Vyas et al, obstructive CAD was detected in one-third of patients who underwent permanent pacemaker implantation [ 16 ]. It was observed that factors such as age equal to or greater than 50 years, male gender, diabetes, and hypertension showed a significant correlation with the presence of CAD.…”

Resolution of Symptomatic Intermittent Sinoatrial Exit Block Associated With Unstable Angina Following Percutaneous Coronary Intervention

“…But these differences in the incidence of CAD in patients with bradyarrhythmia can be attributed to the baseline difference in the characteristics of the population in the two studies. Presence of multiple cardiovascular risk factors in the patient with bradyarrhythmia correlated better with the presence of a CAD [ 15 ]. Our patient who had a bradyarrhythmia underwent a coronary angiogram given the multiple cardiovascular high-risk factors he was having.…”