Mosseri M, Izak T, Rosenheck S, Lotan C, Rozenman Y, Zolti E, Admon D, Gotsman M S
Cardiology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Circulation. 1997 Aug 5;96(3):809-15. doi: 10.1161/01.cir.96.3.809.
The cause of severe cardiac conduction disturbances is often uncertain. The aim of this study was to examine a group of patients with permanent pacemakers who underwent coronary arteriography to determine the extent of coronary atherosclerotic disease that might be responsible for the conduction disturbances.
Forty-three consecutive patients with a permanent pacemaker and 36 matched control patients were investigated. The coronary angiographic study included measurement of diameter and stenosis severity, qualitative assessment of flow, and classification of pathological anatomy, particularly the blood supply to territories supplying the different segments of the conduction system. Among 43 patients with a permanent pacemaker, 27 had ischemic heart disease (17 after coronary artery bypass graft surgery). The conduction disturbance was infranodal in 28 patients, sinus nodal in 6, AV nodal in 4, and complete AV block of unspecified origin in 5. Patients with permanent pacemakers had a coronary artery pathology compromising blood flow to the septal branches and the right coronary artery (type IV anatomy). This pattern was significantly different from the matched control patients, in whom the most prevalent coronary anatomy was the combination of right coronary artery with distal left anterior descending artery (not involving the septal branches) lesions (P=.007).
Patients with coronary artery disease and severe conduction disturbances that require implantation of permanent pacemakers are more likely to have a specific pathological coronary anatomy that combines a compromised blood flow to the septal branches of the left anterior descending artery with right coronary artery lesions. The location of lesions in the coronary tree rather than severe diffuse atherosclerosis appears to be responsible for the conduction disturbances.
严重心脏传导障碍的病因常常不明。本研究的目的是检查一组植入永久性起搏器并接受冠状动脉造影的患者，以确定可能导致传导障碍的冠状动脉粥样硬化疾病的程度。
对43例连续的永久性起搏器植入患者和36例匹配的对照患者进行了研究。冠状动脉造影研究包括测量血管直径和狭窄严重程度、血流的定性评估以及病理解剖分类，特别是对供应传导系统不同节段区域的血供情况。在43例永久性起搏器植入患者中，27例患有缺血性心脏病（17例为冠状动脉旁路移植术后）。传导障碍位于结下的有28例，位于窦房结的有6例，位于房室结的有4例，5例为原因不明的完全性房室传导阻滞。永久性起搏器植入患者存在冠状动脉病变，影响到间隔支和右冠状动脉的血流（IV型解剖）。这种模式与匹配的对照患者有显著差异，对照患者中最常见的冠状动脉解剖是右冠状动脉合并左前降支远端病变（不累及间隔支）（P = 0.007）。
患有冠状动脉疾病且严重传导障碍需要植入永久性起搏器的患者更有可能具有特定的病理性冠状动脉解剖结构，即左前降支间隔支血流受损合并右冠状动脉病变。冠状动脉树中病变的位置而非严重的弥漫性动脉粥样硬化似乎是导致传导障碍的原因。
