The Incidence of Coronary Artery Disease in Patients with Symptomatic Bradyarrhythmias.

Abstract

SUMMARYSymptomatic bradyarrhythmia occurs most often in aged patients. Most of these patients have multiple coronary risk factors and present with angina-like symptoms. The coexistence of CAD not only has major effects on their prognosis but also influences the long-term care. This study was designed to evaluate the incidence of coexistent CAD in patients with symptomatic bradyarrhythmias and its relationship to conventional coronary risk factors in Chinese people.From May 1996 to April 1998, we prospectively studied all consecutive patients admitted to our institution for symptomatic bradyarrhythmias requiring permanent pacemaker implantation. Coronary angiographies were performed non-selectively at the same session of pacemaker implantation. Based on the presence or absence of CAD, patients were divided into two groups for analysis. Multivariate logistic regression analysis was performed to determine independent predictors of CAD including sex, age, diabetes mellitus (DM), hypertension, hypercholesterolemia, and smoking. The odds-ratio (OR) and 95% confidence interval (CI) were determined.A total of 113 patients [68 males and 45 females, mean age 70.4±8.2 years old (range 45-86)] were included in our study. The diagnosis was sick sinus syndrome in 69 patients (61%) and atrioventricular block in 44 patients (39%). The incidence of CAD based on coronary angiography was 20%. The nodal-related artery was seldom involved among patients with coexistent CAD and symptomatic bradyarrhythmias (9%), and most patients had significant stenosis over LAD (74%). The baseline characteristics and presenting symptoms were not different statistically between patients with or without CAD. Hypercholesterolemia (OR 6.6, p=0.002) and DM (OR 4.7, p=0.020) were the two most significant independent predictors of CAD.In our patients with symptomatic bradyarrhythmias requiring permanent cardiac pacing, the incidence of CAD was 20% as determined by coronary angiography (CAG). Hypercholesterolemia and DM were the two most significant independent predictors for CAD in these patients. The nodal artery was seldom involved in patients with coexistent CAD and symptomatic bradyarrhythmias. (Jpn Heart J 2001; 42: 417-423)

Fibrosis, Electrics and Genetics

“…40, 46 However, postmortem angiography has significant limitations and when the nodal artery was assessed in vivo it was seldom diseased (9%) in patients presenting with significant bradycardia. 47 Two small studies have assessed the prevalence of SAN artery disease in a group of patients with SND and clinical evidence of CAD (angina, prior inferior myocardial infarction or positive stress test). 48, 49 Even in this preselected group there is little evidence of a strong association between SAN artery stenosis (>50% luminal diameter) and resting HR, cSNRT or clinical evidence of SND.…”

“…Among patients presenting with significant bradycardia, traditional coronary risk factors remain the strongest predictor of CAD. 47 There is little evidence for coronary investigation or intervention in patients without angina and unnecessary testing of SND patients may expose them to significant harm.…”

Pacemaker Infections: A 10-Year Experience

“…The overall prevalence of DM in all PPM/ICD recipients at the study centre was not available however other studies report DM in 11.1% of pacemaker recipients over 65 years of age 12 and 15% of patients receiving pacemakers for bradyarrhythmia. 13 Various factors predisposing to PPM/ICD infection have been reported, including advanced age, diabetes, malignancy and immunosuppression, anticoagulation and the presence of a temporary pacing wire. However past PPM/ICD infection, multiple previous procedures 14 and lack of prophylactic antibiotics have been most consistently shown 15 to be significant risk factors.…”

Acute thrombosis of the sinus node artery: arrhythmological implications

“…A recent study evaluated the incidence of coexistent CAD in Chinese people with symptomatic bradyarrhythmias and its relation to coronary risk factors. 4 The incidence of angiographic CAD involving node related arteries was quite high (9%). Furthermore, in a postmortem angiographic study in patients with chronic SN dysfunction, 5 CAD was relatively common, although no significant lesion obstructing blood flow to the SN was seen in the majority of patients.…”