Myocardial perfusion in patients with permanent ventricular pacing and normal coronary arteries

Skalidis, Emmanuel I.; Kochiadakis, George E.; Koukouraki, Sophia; Chrysostomakis, Stavros I.; Igoumenidis, Nikolaos E.; Karkavitsas, Nikolaos; Vardas, Panos

doi:10.1016/s0735-1097(00)01096-2

Cited by 99 publications

(64 citation statements)

References 25 publications

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“…При проведении сцинти-графии миокарда обнаружено, что у 46-75% пациентов с ПЖ-стимуляцией выявляются дефекты перфузии, не свя-занные со стенозирующим поражением коронарных арте-рий [27,36]. Наиболее частая их локализация -нижняя стенка, верхушка, межжелудочковая перегородка.…”

Section: патогенез неблагоприятных последствий апикальной пж-стимуляцииunclassified

“…В на-стоящее время установлено, что дефекты перфузии не являются артефактами на томосцинтиграммах, возника-ющими за счет эффекта частичного объемного уменьше-ния массы миокарда вследствие дисинхронии, как это на-блюдается при полной блокаде левой ножки пучка Гиса, а отражают истинное нарушение перфузии мышцы сердца [8]. Наиболее вероятно, что нарушения перфузии обу-словлены перераспределением коронарного кровотока вследствие ауторегуляции сосудистого тонуса из-за раз-ницы преднагрузки на различные участки миокарда [1, 8,27]. Другими возможными механизмами могут являться вазоконстрикция вследствие повышения тканевого нор-эпинефрина в зоне стимуляции [18,26] и поражение ми-кроциркуляторного русла за счет фиброзно-дегенератив-ных процессов [12].…”

Section: патогенез неблагоприятных последствий апикальной пж-стимуляцииunclassified

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Importance of the heart failure mechanisms during permanent single-chamber cardiac pacing for optimization of rate-adaptive mode

Kuznetsova¹,

Андреев²,

Сыркин³

et al. 2015

Kardiol. serdechno-sosud. khir.

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При постоянной электрокардиостимуляции сердца риск сердечной недостаточности (СН) повышен. В настоящем обзоре освещены механизмы развития СН при однокамерной электрокардиостимуляции сердца и основные подходы к преодолению данной проблемы. Особое внимание уделено обсуждению возможностей оптимизации режима частотной адаптации для уменьшения СН. Ключевые слова: постоянная однокамерная электрокардиостимуляция сердца, апикальная правожелудочковая стимуля-ция, хронотропная некомпетентность, сердечная недостаточность, режим частотной адаптации.The risk of heart failure in increased in case of permanent cardiac pacing. Heart failure mechanisms during permanent singlechamber cardiac pacing and main approaches to overcome these problems are being discussed in the review. Possibilities to optimize rate-adaptive modes for heart failure reducing are emphasized.Keywords: permanent single-chamber cardiac pacing, apical right ventricular pacing, chronotropic incompetence, heart failure, rate-adaptive mode.

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Section: патогенез неблагоприятных последствий апикальной пж-стимуляцииunclassified

Importance of the heart failure mechanisms during permanent single-chamber cardiac pacing for optimization of rate-adaptive mode

Kuznetsova¹,

Андреев²,

Сыркин³

et al. 2015

Kardiol. serdechno-sosud. khir.

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“…The two groups were studied together since both exhibit similar conduction characteristics on the ECG and secondly due to perfusion abnormalities not related to coronary artery disease that trouble SPECT analysis [8,10,23]. Only reports that carried information on the number of cardiac events in terms of prognosis were selected, whereas reports on the diagnostic accuracy of SPECT were left out.…”

Section: Search Of the Medline Database (January 1980 Tomentioning

confidence: 99%

“…However, in patients with an intrinsic left bundle branch block (LBBB) and in patients with right ventricular apical (RVA) pacing, its diagnostic accuracy and prognostic value is reduced [8][9][10][11][12]. False-positive perfusion defects in the septal region in intrinsic LBBB and in the inferoseptal wall in RVA pacing are the main causes of decreased diagnostic accuracy [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Patients with left bundle branch block pattern and high cardiac risk myocardial SPECT: does the current management suffice?

et al. 2011

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Introduction Myocardial perfusion SPECT (MPS) is frequently used for cardiovascular risk stratification. The significance of MPS in patients with abnormal electrical ventricular activation is often questionable. This review assesses the value of MPS for risk stratification of patients with intrinsic left bundle branch block or that due to right ventricular apical pacing. Methods We reviewed the literature by a search of the MEDLINE database (January 1980 to September 2010). The terms prognosis or prognostic value were combined with SPECT and LBBB or pacing or pacemakers. MPS was categorised as low and high risk according to the original definitions. Results We identified 11 studies suitable for review. A lowrisk MPS is associated with a low risk of cardiac events whereas high-risk MPS carries a 4.8-fold increased risk, 95% CI [3.2 -7.2] (p < 0.0001). Despite secondary prevention and an improved medical and interventional care, these figures have hardly changed over time. Conclusion and clinical implications A low-risk MPS permits a policy of watchful waiting whereas a high-risk MPS requires further analysis and treatment. The persistent high cardiac death and acute myocardial infarction rate after a high-risk MPS suggest that the current management of these patients does not suffice and needs reconsideration.

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“…1) Perfusion scintigraphy may have low specificity or sensitivity in patients with a conventional, permanent PM, 2) which is perhaps due to the impaired coronary flow reserve that's caused by alterations of left ventricular mechanical activation and the increased extramural compressive forces. 3) Noninvasive pacemaker stress echocardiography (PASE) can increase the heart rate and induce myocardial ischemia in these patients. 4,5) We evaluated the diagnostic accuracy of performing noninvasive PASE as a screening test for coronary artery disease in patients with atypical angina and a permanent pacemaker.…”

Section: Introductionmentioning

confidence: 99%

Noninvasive Pacemaker Stress Echocardiography as a Screening Test for Coronary Artery Disease in Patients With Atypical Angina and Permanent Pacemaker

et al. 2008

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Background and Objectives: Making the noninvasive diagnosis of coronary artery disease in patients with a permanent pacemaker is difficult because of the inability to interpret electrocardiograms and the low specificity of perfusion scintigraphy. We evaluated the diagnostic accuracy of noninvasive pacemaker stress echocardiography (PASE) as a screening test for coronary artery disease in patients with atypical angina and a permanent pacemaker. Subjects and Methods: This a prospective study, and transthoracic stress-pacing echocardiography was performed on 15 patients (9 men and 6 women; age, mean age: 71.1±11.0 years) with atypical angina and a permanent pacemaker. All the patients underwent noninvasive pacemaker-stress echocardiography by external programming (pacing the heart rate up to 150 beats per minute). Coronary angiography was performed on the 8 patients with positive PASE results. Significant coronary artery disease was defined as ≥70% stenosis in at least one major coronary artery. Results: The echocardiographic images were interpretable for all the patients. No significant side effects were observed. The left ventricular systolic function was preserved in all the patients (left ventricular ejection fraction; 63.5±8%). Only 5 (62.5%) of 8 patients showed significant coronary artery disease, as documented by coronary angiography. Conclusion: Noninvasive PASE is a simple, rapid, safe and diagnostically efficient test for detecting coronary artery disease in patients with atypical angina and a permanent pacemaker. Larger studies are necessary to validate our findings.

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Myocardial perfusion in patients with permanent ventricular pacing and normal coronary arteries

Cited by 99 publications

References 25 publications

Importance of the heart failure mechanisms during permanent single-chamber cardiac pacing for optimization of rate-adaptive mode

Importance of the heart failure mechanisms during permanent single-chamber cardiac pacing for optimization of rate-adaptive mode

Patients with left bundle branch block pattern and high cardiac risk myocardial SPECT: does the current management suffice?

Noninvasive Pacemaker Stress Echocardiography as a Screening Test for Coronary Artery Disease in Patients With Atypical Angina and Permanent Pacemaker

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