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.
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.
Authors: Mohammad S Alai; Jahangir Rashid Beig; Sanjay Kumar; Irfan Yaqoob; Imran Hafeez; Ajaz A Lone; Mohammad Iqbal Dar; Hilal A Rather Journal: Indian Heart J Date: 2016-06-29