Electrocardiographic changes after successful recanalization of a chronic total coronary occlusion. A systematic
Ivo M van Dongen1, Joëlle Elias1, Veronique M F Meijborg1
1Department of Cardiology, Academic Medical Center Amsterdam, The Netherlands.
Insights
Successful percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) improves electrophysiological parameters, potentially reducing arrhythmia risk. This suggests hibernating myocardium in CTO regions may be more responsive than previously thought.
Area of Science:
- Cardiology
- Electrophysiology
- Interventional Cardiology
Background:
- Observational studies link successful chronic total occlusion (CTO) recanalization to improved clinical outcomes.
- This benefit may stem from reduced arrhythmias due to modifications in hibernating myocardium within CTO regions.
Purpose of the Study:
- To evaluate the impact of CTO percutaneous coronary intervention (PCI) on electrophysiological parameters.
- To conduct a systematic review and meta-analysis on the effects of successful CTO PCI on ECG parameters.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA guidelines.
- Searched MEDLINE and EMBASE databases.
- Included eight studies with 467 patients evaluating successful CTO PCI's effect on ECG parameters.
Main Results:
- Successful CTO PCI significantly decreased mean QT dispersion by 17.46ms and QTc dispersion by 18.74ms.
- One study reported significant decreases in Tp-e interval and Tp-e/QT ratio in specific leads post-CTO PCI.
Conclusions:
- Successful CTO PCI is associated with an immediate reduction in ECG parameters indicating heterogeneous depolarization and repolarization.
- This reduction may lower the risk of ventricular arrhythmias and sudden cardiac death.
- Hibernating myocardium in CTO regions might be more adaptable than presumed.
Background:
Observational studies suggest that in patients with a CTO successful recanalization is associated with better clinical outcome. This could be related to a reduction in the occurrence of arrhythmias, which may result from modifications of the hibernating myocardium in a CTO region.
Methods And Results:
We aimed to evaluate the effect of CTO PCI on electrophysiological parameters, and conducted a systematic review and meta-analysis according to the PRISMA guidelines. MEDLINE and EMBASE were searched. Titles and abstracts identified by the search strategy were independently screened by two investigators. Data were extracted and used for meta-analyses where possible. In total, eight studies incorporating 467 patients were included in this review, evaluating the effect of successful CTO PCI on various ECG parameters. Three studies showed a significant decrease in mean QT dispersion of 17.46ms [95% CI 10.62-24.30] after successful CTO PCI. QTc dispersion also decreased significantly, with a mean decrease of 18.74ms [95% CI 11.53-25.94]. In one trial a significant decrease in Tp-e interval in leads V2 and V5, and a significant decrease in Tp-e/QT ratio in leads V2 and V5 post-CTO PCI were observed.
Conclusions:
This first systematic review and meta-analysis suggests that successful CTO PCI is associated with an immediate decrease in ECG parameters that reflect heterogeneity in depolarization and repolarization, which could lead to a reduction in the risk for ventricular arrhythmias and sudden cardiac death. We raise the hypothesis that hibernating myocardium in a CTO region may not be as deeply "in sleep" as one would assume.
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