Should We Revascularize Before Implanting a Pacemaker?

• Published in: Clinical cardiology (Mahwah, N.J.) Vol. 31; no. 10; pp. 498 - 501
• Main Authors: Yesil, Murat, Bayata, Serdar, Arikan, Erdinc, Yilmaz, Rustem, Postaci, Nursen
• Format: Journal Article
• Language: English
• Published: New York Wiley Periodicals, Inc 01-10-2008; Wiley
• Subjects: Aged; Atrioventricular Block - complications; Atrioventricular Block - physiopathology; Atrioventricular Block - therapy; Biological and medical sciences; Cardiac Pacing, Artificial - methods; Cardiology. Vascular system; Clinical Investigation; Clinical Investigations; coronary artery disease; Coronary Disease - complications; Coronary Disease - physiopathology; Coronary Disease - surgery; Coronary heart disease; Electrocardiography; Female; Follow-Up Studies; Heart; Humans; Male; Medical sciences; Middle Aged; Myocardial Revascularization - methods; pacemaker implantation; Pacemaker, Artificial; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retrospective Studies; revascularization; Time Factors; Treatment Outcome; coronary artery disease; Instrumental stimulation; Pacemaker; pacemaker implantation; Instrumentation therapy; Cardiovascular disease; Implantation; Circulatory system; Cardiology; Coronary heart disease; Phlebology; Revascularization
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.20280

Background
The effect of coronary revascularization on disappearance of the severe conduction disturbances is still unclear.
Hypothesis
We sought to determine whether revascularization may induce recovery of sinus rhythm in patients with significant coronary artery disease and complete atrioventricular block (AVB).
Methods
Fifty‐three patients who had third‐degree AVB and significant coronary artery disease were enrolled. Patients with acute coronary syndromes were excluded. Thirty‐three (62%) patients were men and the mean age was 65 ± 10 y. All patients received a permanent dual‐mode, dual‐pacing, dual‐sensing (DDD) pacemaker. Coronary disease was treated medically in 16 (30%) patients due to patient preference or ineligibility. Thirty‐seven (70%) patients underwent a revascularization procedure (coronary artery bypass grafting [CABG]: 16, percutaneous coronary intervention [PCI]: 21 pts). Mean follow‐up was 36 ± 6 mo and patients were evaluated every 3 mo according to their resting electrocardiograms (ECGs) at each visit.
Results
In the medically treated group, 13 (81%) patients still had third‐degree AVBs at the end of the follow‐up period, while 3 (19%) patients returned to normal sinus rhythm. On the other hand, 27 out of 37 patients (73%) who were revascularized were still in complete AVB, and 10 patients from this group (27%) had returned to normal sinus rhythm. There was no statistically significant difference between the revascularized and medically treated groups in terms of need for a pacemaker.
Conclusions
Patients who have concomitant severe conduction disturbances and significant coronary disease may well receive a pacemaker before a revascularization procedure. Our data shows that coronary revascularization has little, if any, impact on returning to normal AV conduction. Copyright © 2008 Wiley Periodicals, Inc.