Effect of coronary occlusion on intracardiac electrogram morphology
G Stuart Mendenhall1, Firas Zahr, Sanjoy Bhattacharya
1Heart and Vascular Institute of the University of Pittsburgh, Pittsburgh, PA, USA.
Summary
Coronary occlusion causes specific changes in intracardiac electrograms (IKG), enabling detection and localization of blocked coronary arteries. This finding may improve acute coronary syndrome diagnosis in patients with ischemic heart disease.
Area of Science:
- Cardiology
- Electrophysiology
- Ischemic Heart Disease Research
Background:
- Intracardiac electrograms (IKG) morphology changes during coronary occlusion are poorly understood.
- Assessing ischemic heart disease (IHD) risk and diagnosing acute coronary syndromes (ACS) requires better diagnostic tools.
Purpose of the Study:
- To investigate the impact of total coronary artery occlusions on intracardiac electrograms (IKG).
- To determine if IKG changes can help localize the affected coronary artery.
Main Methods:
- Pigs underwent implantation of cardiac implantable electronic devices (CIED) with atrial and ventricular leads.
- Percutaneous balloon occlusion of major coronary arteries was performed, with simultaneous 15-vector IKG and 12-lead ECG recordings.
- IKG and ECG were analyzed during occlusions and compared to baseline.
Main Results:
- Coronary occlusions consistently induced significant ST-segment changes in both IKG and ECG.
- These ST-segment disturbances were reproducible and specific to the occluded coronary artery.
- IKG analysis revealed distinct signatures for each occluded vessel, allowing for localization.
Conclusions:
- Total coronary occlusion generates characteristic IKG changes indicative of injury.
- These IKG patterns can accurately detect and localize the culprit coronary artery.
- Applying these findings to patients with IHD could expedite ACS diagnosis and improve outcomes.
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