[Cardiac pacemaker therapy for optimizing brain circulation. A possible prevention for cerebrovascular diseases?].
METHODS
A 78-year-old patient experienced dizziness, impairment of mnemic and cognitive function, chronic fatigue and recurrent syncope.


METHODS
Hypertensive heart disease, reduced left ventricular function, and ventricular ectopia classification Lown IVb was documented. Computed tomography showed minimal brain atrophia. Stenoses of the brain supplying arteries and of other intracranial diseases were excluded. A distinct correlation between cardiac output and cerebral blood flow in correspondence to changes of heart rate were found (cardiac output 4.2 l/min during sinus rhythm, 7.4 l/min during temporary atrial pacing--AAI-Mode with a pacing rate of 90/min; 4.8 l/min--AAI-Mode with a pacing rate of 120/min; cerebral blood flow: 70, 74 and 62 ml/100 g per minute, respectively). Thus, impairment of cerebral blood flow autoregulation can be assumed.


METHODS
After implantation of a permanent pacemaker the patient was without any complaints. The mnemic and cognitive function improved, dizziness and fatigue disappeared. Synopsis did not occur. 14 months later a sudden onset of complaints occurred caused by atrial fibrillation (heart rate 120/min). Cardiac output and cerebral blood flow were now 4.0 l/min and 35 ml/100 g per minute. After antiarrhythmic drug therapy and restoration of sinus rhythm cardiac output and cerebral blood flow increased and the complaints disappeared again.


CONCLUSIONS
In patients with impaired capacity of cerebral autoregulation a reduced cardiac function and output can induce a reduction of cerebral blood flow. Thus, impairment of mnemic and cognitive function as well as other unspecific neurological deficits can be caused. In these cases pacemaker therapy has to be discussed as an effective therapeutical concept.
Hagendorff
A
A
Medizinische Universitätsklinik und Poliklinik, Leipzig. hagendorff@gmx.net
Dettmers
C
C
Jung
W
W
Hümmelgen
M
M
Kölsch
C
C
Hartmann
A
A
Lüderitz
B
B
Pfeiffer
D
D
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000503:physiopathology; D001921:Brain / Q000098:blood supply*; D002302:Cardiac Output; D002304:Cardiac Pacing, Artificial; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003072:Cognition Disorders / Q000517:prevention & control; D004244:Dizziness / Q000517:prevention & control; D015150:Echocardiography, Doppler; D005221:Fatigue / Q000517:prevention & control; D006339:Heart Rate; D006801:Humans; D008297:Male; D008569:Memory Disorders / Q000517:prevention & control; D010138:Pacemaker, Artificial; D012039:Regional Blood Flow; D013575:Syncope / Q000517:prevention & control; D013815:Thermodilution
D000889:Anti-Arrhythmia Agents