Institute of Cardiology, Warsaw, Poland.
Kardiol Pol. 2009 Aug;67(8):875-81.
Electrocardiographic abnormalities and clinical symptoms are used as indications for cardiac pacing. Syncope, faints and other neurological symptoms are of multi-factorial origin and are due to reduced brain perfusion.
To examine the carotid and vertebral artery blood flow and to assess whether stenosis of these arteries is associated with symptoms of cerebral hypoperfusion in patients undergoing pacemaker implantation.
In 152 consecutive patients (84 men, age 70.6+/-10 years), admitted for pacemaker implantation from January 2003 to June 2004, ultrasonographic and colour Doppler examinations of the carotid and vertebral arteries were performed. The patient's medical history and symptoms, conduction disturbances, and modes of pacing were evaluated using a uniform questionnaire. Clinical manifestations of atherosclerosis were present in 21% (remote myocardial infarction) and 8% (stroke) of patients. Patients were divided into 2 groups: asymptomatic subjects (25%) and those with symptoms of cerebral hypoperfusion (75%).
There were no significant differences in indications and modes of pacing between the groups; only second degree atrioventricular block was significantly more frequent in patients without symptoms (p=0.0163). Prevalence of either common or internal carotid artery stenosis>50% was higher in symptomatic than asymptomatic patients (32 vs. 16, p<0.05). Multivariate analysis revealed a 3.5 times higher probability of Stokes-Adams attacks and syncope in patients with confirmed atherosclerotic lesions (OR 3.5, 95% CI 1.2-13.4; p=0.0351). Blood flow disturbances in vertebral arteries were more frequent in symptomatic patients: 26 vs. 11%, p=0.0438. The lowest risk of loss of consciousness was observed in patients with second degree atrioventricular block, with no atherosclerotic lesions: (OR 0.2; 95% CI 0.03-0.06; p=0.0102).
Prevalence of atherosclerotic lesions in carotid and vertebral arteries is higher in symptomatic patients referred for pacemaker implantation. The lowest risk of symptoms was found in patients with a second degree atrioventricular block and no atherosclerotic lesions. Ultrasonographic examination of carotid and vertebral arteries should be considered in all symptomatic patients with indications for pacemaker implantation.
心电图异常和临床症状被用作心脏起搏的指征。晕厥、昏倒和其他神经症状是多因素的起源，是由于脑灌注减少。
检查颈动脉和椎动脉的血流，并评估这些动脉狭窄是否与接受起搏器植入的患者的脑灌注不足症状有关。
在 2003 年 1 月至 2004 年 6 月期间，连续对 152 例（84 例男性，年龄 70.6+/-10 岁）因起搏器植入而入院的患者进行了颈动脉和椎动脉的超声和彩色多普勒检查。使用统一的问卷评估患者的病史和症状、传导障碍和起搏方式。21%（陈旧性心肌梗死）和 8%（中风）的患者存在动脉粥样硬化的临床表现。患者分为两组：无症状组（25%）和脑灌注不足症状组（75%）。
两组之间的起搏指征和方式无显著差异；只有无症状组患者的二度房室传导阻滞更为常见（p=0.0163）。有症状患者的颈内或颈总动脉狭窄>50%的发生率高于无症状患者（32%比 16%，p<0.05）。多变量分析显示，有动脉粥样硬化病变的患者发生 Stokes-Adams 发作和晕厥的可能性增加 3.5 倍（OR 3.5，95%CI 1.2-13.4；p=0.0351）。症状患者椎动脉血流紊乱更为常见：26%比 11%，p=0.0438。在无动脉粥样硬化病变且二度房室传导阻滞的患者中，意识丧失的风险最低（OR 0.2；95%CI 0.03-0.06；p=0.0102）。
在因起搏器植入而接受治疗的有症状患者中，颈动脉和椎动脉的动脉粥样硬化病变发生率较高。在无动脉粥样硬化病变且二度房室传导阻滞的患者中，症状的风险最低。对于有起搏器植入指征且有症状的所有患者，都应考虑进行颈动脉和椎动脉的超声检查。
