Does coronary artery disease go hand-in-hand with bradyarrhythmias? An observational study from Eastern India

Aim. Many patients with conduction system disorders have associated heart conditions, especially ischemic heart disease. This study was designed to assess the prevalence and pattern of coronary artery disease (CAD) in patients with bradyarrhythmias requiring permanent pacemaker and association with CAD risk factors. Material and methods. This single-centre observational cohort study included 80 patients with mean age of 63±9.4 years, admitted with symptomatic bradyarrhythmias. Patients underwent coronary angiography after obtaining informed consent and prevalence and pattern of CAD were analyzed in them. CAD was defined as narrowing in major epicardial coronary arteries or their first order branches and obstructive CAD as ≥50% stenosis. CAD was further categorized as single vessel disease, double vessel disease and triple vessel disease and any association with conduction system disorders studied. Results. CAD was present in 56% patients and obstructive CAD in 37.5% patients. 19% patients had single vessel disease, while 18% had multi-vessel CAD. Obstructive LAD disease was seen in 25% of patients, followed by right coronary artery in 21.3% patients and LCX in 15% of patients. Heart team advised revascularization in majority (75%) of patients with obstructive CAD. AV nodal artery disease was found more in patients of complete heart block (p=0.0359). Among various risk-factors, dyslipidemia (56.7% vs 22%, p=0.0016), family history of CAD (63.3% vs 18%, p<0.0001) and angina (53.3% vs 20%, p=0.0020) showed significant association with obstructive CAD. RWMA on echocardiography (50% vs 14%, p=0.0004) and lower mean left ventricular ejection fraction (52.7% vs 58.1%, p=0.0270) also showed significant association with obstructive CAD. Conclusion. In patients requiring permanent pacemaker, coexistent obstructive CAD was noted in 37.5% of the subjects. Causal association between obstructive CAD and conduction disturbances may not be established from this data, but the increased prevalence of atherosclerotic cardiovascular disease in patients having bradyarrhythmias implies the need for larger multi-center trials to understand the causal association and plan for earlier management.