Detection of coronary artery disease in patients with a permanent pacemaker.

摘要

Cardiac pacing has been used in the treatment of bradyarrhythmia for more than 50 years, and throughout that time period both clinical practice and an impressive amount of research have objectively proven its effectiveness. Especially in the last decade the number of patients treated with a permanent pacemaker implantation has increased, and due to the aging of the population this number continue to grow [1]. Importantly, the prevalence of coronary artery disease (CAD) in these patients is high and most patients will develop symptoms suggestive of angina pectoris. As a consequence, the use of noninvasive testing has increased in these vulnerable subjects to prevent additional invasive assessment or intervention. Non-invasive methods for the detection and diagnosis of CAD in patients with a permanent pacemaker, recommended by the American College of Cardiology/American Heart Association (ACC/AHA) guidelines, include adenosine or dipyridamole perfusion imaging and dobutamine stress echocardiography [2]. However, in the last decade studies have demonstrated pitfalls and weaknesses of these imaging modalities in patients with a permanent pacemaker [3-6]. Single-photon emission computed tomography (SPECT) with either thallium or technetium is routinely used for ischemia detection, but in patients with a pacemaker perfusion defects that were not related to obstructive CAD have been demonstrated [3, 6].