Optimizing cerebral blood flow by pacemaker-therapy - a possible issue to prevent of cerebrovascular diseases?

History and clinical findings: A 78-year-old patient experienced dizziness, impairment of mnemic and cognitive function, chronic fatigue and recurrent syncope. Investigations: Hypertensive heart disease, reduced left ventricular functi on, and ventricular ectopia classification Lown IVb was documented. Compute d tomography showed minimal brain atrophia. Stenoses of the brain supplying arteries and of other intracranial diseases were excluded. A distinct corr elation between cardiac output and cerebral blood flow in correspondence to changes of heart rate were found (cardiac output 4.2 I/ min during sinus r hythm, 7.4 I/min during temporary atrial pacing - AAI-Mode with a pacing ra te of 90/min; 4.8 I/min - AAI-Mode with a pacing rate of 120/min; cerebral blood Row: 70, 74 and 62 ml/100g per minute, respectively). Thus, impairmen t of cerebral blood Row autoregulation can be assumed. Treatment and course: After implantation of a permanent pacemaker the patie nt was without any complaints. The mnemic and cognitive function improved, dizziness and fatigue disappeared. Syncopies did not occur. 74 months later a sudden onset of complaints occured caused by atrial fibrillation (heart rate 120/min). Cardiac output and cerebral blood flow were now 4.0 I/min an d 35ml/100g per minute. After antiarrhythmic drug therapy and restoration o f sinus rhythm cardiac output and cerebral blood flow increased and the com plaints disappeared again. Conclusion: In patients with impaired capacity of cerebral autoregulation a reduced cardiac function and output can induce a reduction of cerebral blo od flow. Thus, impairment of mnemic and cognitive function as well as other unspecific neurological deficits can be caused. In these cases pacemaker t herapy has to be discussed as an effective therapeutical concept.