Терапевтический архив (Dec 2004)
A clinical courseof coronary heart disease after pacemaker implantation andoptimization of the pacing regime
Abstract
Aim. 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. Material and methods. A total of 154 CHD patients with a pacemaker were examined. All the patients had angina of effort of functional class 11-IV. Results. The symptoms of the disease improved in 72 (46.8%) patients (group I): 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. Conclusion. To optimize coronary reserve, frequency of electroimpulses must be reprogrammed to adjust to afunctional 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.
