Incidence of coronary artery disease and necessity of revascularization in symptomatic patients requiring permanent pacemaker implantation.

Background And Purpose: The cause of severe cardiac conduction disturbances or sinus node dysfunction is often unknown. The objective of this study was to assess the incidence of coronary artery disease (CAD) and the necessity of revascularization in patients with symptomatic bradycardia requiring permanent pacemaker implantation and to try to find a causal association between the need for a pacemaker and the presence of CAD.

Patients And Methods: From January 2002 to December 2005, 507 pacemakers were implanted due to symptomatic bradycardia. In the presence of at least one atherosclerotic risk factor, patients were recommended to undergo coronary angiography. Each patient underwent exercise or dobutamine echocardiography to detect myocardial ischemia.

Results: 212 of the 507 patients (42%) with permanent pacemaker implantation (141 men, mean age 70 +/- 9 years) underwent coronary angiography within 2 months before or after pacemaker implantation. Twelve patients (6%) had a normal angiogram. No significant CAD was found in 37 patients (17%), and significant narrowing of the coronary arteries in 150 (71%). Conservative treatment was recommended in 128 patients (60%), 40 patients (19%) were treated with percutaneous coronary intervention, and 44 patients (21%) underwent coronary artery bypass grafting.

Conclusion: The data indicate that patients with severe conduction disturbances or sinus node dysfunction requiring permanent pacemaker implantation are more likely to have CAD with subsequent myocardial revascularization in the presence of at least one atherosclerotic risk factor. A causal association between the need for pacemaker and CAD could not be established from the results.