Iskanderov B G, Minkin A A, Vakina T N
Ter Arkh. 2004;76(12):23-7.
To study effects of pacemaker implantation on the course of coronary heart disease (CHD) with stable angina pectoris and choice of optimal regimen of pacing.
A total of 154 CHD patients with a pacemaker were examined. All the patients had angina of effort of functional class II-IV.
The symptoms of the disease improved in 72 (46.8%) patients (group 1): the number of anginal attacks decreased, exercise tolerance increased, the dose of antianginal medicines went down. Pain attacks became more frequent, response to nitroglycerin changed in 30 (19.5%) patients of group 2. This was explained by 1.5-2-fold enhancement of heart rate by pacemaker raising myocardial oxygen consumption and psychocardial syndrome. In 52 (33.8%) patients of group 3 anginal attacks characteristics did not change.
To optimize coronary reserve, frequency of electroimpulses must be reprogrammed to adjust to a functional class of angina and chronic cardiac failure as well as pacing regime. In particular, low coronary reserve demands optimal frequency of 55-65 imp/min while congenital cardiac failure--75-85 imp/min.
研究起搏器植入对稳定型心绞痛冠心病病程的影响以及最佳起搏方案的选择。
共检查了154例植入起搏器的冠心病患者。所有患者均有II-IV级劳力性心绞痛。
72例（46.8%）患者（第1组）病情改善：心绞痛发作次数减少，运动耐量增加，抗心绞痛药物剂量降低。第2组30例（19.5%）患者疼痛发作更频繁，对硝酸甘油的反应改变。这是由于起搏器使心率提高1.5 - 2倍，增加了心肌耗氧量和心理心脏综合征。第3组52例（33.8%）患者心绞痛发作特征未改变。
为优化冠状动脉储备，必须重新调整电脉冲频率，以适应心绞痛功能分级和慢性心力衰竭以及起搏方案。特别是，冠状动脉储备低时，最佳频率为55 - 65次/分钟，而先天性心力衰竭时为75 - 85次/分钟。
