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Transcoronary pacing to assess myocardial viability prior to percutaneous coronary intervention: Pilot study to
James O'Neill1, Andrew J Hogarth1, Ian Pearson1
1Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, United Kingdom.
Insights
Trans-coronary pacing (TCP) can differentiate normal from scarred myocardium using impedance and pacing threshold measurements. Further research is needed to determine if TCP can distinguish viable from nonviable myocardium before percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Medical Devices
- Electrophysiology
Background:
- Assessing myocardial viability is critical for successful percutaneous coronary intervention (PCI).
- Trans-coronary pacing (TCP) is a potential method for evaluating myocardial viability.
Purpose of the Study:
- To investigate the association between electrical parameters measured during TCP and myocardial viability.
- To determine if TCP can differentiate between normal and scarred myocardium.
Main Methods:
- Patients with significant coronary stenosis undergoing PCI were recruited.
- Cardiac MRI assessed myocardial viability.
- Coronary guidewire measured pacing threshold, impedance, and R-wave amplitude in myocardial segments prior to PCI.
Main Results:
- Impedance and pacing threshold differed significantly between normal and scarred myocardium (P=0.12 and P=0.002).
- No significant differences were found between varying degrees of myocardial scarring (<50% vs. ≥50%).
- Pacing sensitivity did not differ significantly between normal and scarred myocardium.
Conclusions:
- Impedance and pacing threshold during TCP can distinguish normal from scarred myocardium.
- Further investigation is required to ascertain TCP's ability to differentiate viable from nonviable myocardium.
Background:
The assessment of myocardial viability is crucial before percutaneous coronary intervention (PCI) is carried out to ensure that the patient will gain benefit. Trans-coronary pacing (TCP) has previously been used to pace myocardium but may also provide information on myocardial viability.
Methods:
Patients with a single, significant coronary stenosis requiring PCI were recruited. They underwent a cardiac MRI to assess myocardial viability. Prior to PCI, a coronary guidewire was used to measure pacing threshold, impedance, and R-wave amplitude in different myocardial segments to determine any association between the electrical parameters and myocardial viability.
Results:
Eight patients were recruited and six patients underwent intervention. Pacing sensitivity did not demonstrate statistically significant differences between normal and scarred myocardium. Impedance demonstrated a mean of 304.8 ± 74.0 Ω in normal myocardium (NM), 244.1 ± 66.6 Ω in <50% myocardial scar (MS), and 222.3 ± 33.8 Ω in ≥50% MS. Pacing threshold demonstrated a mean of 1.960 ± 1.226 V in NM, 5.009 ± 2.773 V in <50% MS, and 3.950 ± 0.883 V in ≥50% MS. For both impedance and threshold, there was a significant difference among the groups (P = 0.12 and P = 0.002, respectively), and post hoc Tukey's pairwise comparison demonstrated significant differences between NM and scarred myocardium. No significant differences were found between <50% MS and ≥50% MS.
Conclusions:
Impedance and pacing threshold, measured during TCP, can be used to differentiate between normal myocardium and scarred myocardium. Further research is needed to determine whether TCP can discriminate between viable and nonviable myocardium.
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