Comparative evaluation of permanent cardiac pacing modes in patients with arrhythmic variant of coronary artery disease (bradyarrhythmia)

Abstract

Aim – to analyze and compare the results of permanent cardiac pacing therapy in patients with arrhythmic variant of coronary artery disease (CAD) (grade II – III AV block and sinus node weakness syndrome). Material and methods. We studied the results of examination of 63 patients with arrhythmic variant of coronary artery disease (sinus node weakness syndrome and AV block), who received pacing therapy in VVI and DDD modes in the Department of Rhythm and Conduction Disorders of the Republican Clinical Hospital No. 4. All patients underwent clinical, laboratory and instrumental tests in accordance with federal clinical guidelines for CAD, rhythm and conduction disorders. Results. The left ventricular ejection fraction (LVEF) in patients with pacemakers in VVI mode was 9% lower when compared to LVEF in DDD mode. Mitral regurgitation was 47.6% more common in patients having VVI mode than DDD mode. In patients with the VVI regimen, the interventricular septal asynchrony was 25.1% more common and was accompanied by more pronounced left ventricle hypertrophy and dysfunction. Pacemaker syndrome was observed in 3 (7.5%) patients with VVI stimulation mode, stopped by reimplantation of a two-chamber frequency–adaptive pacemaker, and in 1 (4.35%) patient with DDD mode, eliminated by reprogramming. Conclusion. In patients with coronary artery disease, the effectiveness of pacing in correction of the cardiac rhythm and conduction depends on the treatment mode. Disorders of myocardial contractility are more pronounced in patients with VVI mode, if compared to DDD mode.