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The Impact of Coronary Sinus Reducer on Arrhythmic Properties in Patients with Refractory Angina
Miha Mrak1,2, Tadej Žlahtič1,2, Vito Starc3
1Department of Cardiology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia.
Insights
Coronary sinus reducer (CSR) implantation did not significantly alter high-resolution electrocardiogram (hrECG) parameters related to arrhythmogenic substrate compared to a sham procedure in refractory angina patients. Further research is needed to explore potential antiarrhythmic effects.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Coronary sinus reducer (CSR) is a novel treatment for refractory angina.
- Preclinical studies suggest coronary sinus narrowing may possess antiarrhythmic properties.
- The antiarrhythmic potential of CSR implantation in humans remains uninvestigated.
Purpose of the Study:
- To evaluate the antiarrhythmic effects of CSR implantation.
- To assess changes in high-resolution electrocardiogram (hrECG) parameters post-CSR implantation.
Main Methods:
- 24 refractory angina patients from the Crossroad study were randomized to CSR (n=12) or sham (n=12).
- High-resolution electrocardiogram (hrECG) was recorded at baseline and 6-month follow-up.
- Analyzed parameters included TpTe interval, QRS-T angle (QRSTP, QRSTM), spatial ventricular gradient (SVG), QT interval, and heart rate variability.
Main Results:
- Baseline hrECG parameters were comparable between CSR and sham groups.
- No significant intragroup changes were observed in TpTe, QRSTP, QRSTM, SVG, QT, or heart rate variability at follow-up.
- Intergroup comparison revealed no significant differences in the changes of analyzed parameters between CSR implantation and sham procedures.
Conclusions:
- CSR implantation did not demonstrate a significant impact on the arrhythmogenic substrate as assessed by hrECG parameters.
- The study found no significant antiarrhythmic effect of CSR implantation compared to a sham procedure.
Background:
Treatment with a coronary sinus reducer (CSR) is a new therapeutic option for refractory angina patients. Preclinical studies have shown antiarrhythmic properties of coronary sinus narrowing. The possible antiarrhythmic effect of CSR implantation is unknown. This study aimed to determine the possible antiarrhythmic effects of CSR implantation as assessed by high-resolution electrocardiogram (hrECG) parameters.
Methods:
24 patients from the Crossroad study randomized to either CSR treatment (n = 12) or a sham procedure (n = 12) had hrECG recorded at baseline and after 6 months. T-peak and T-end interval (TpTe) defined as the time difference between the peak amplitude of the T wave and the global end of the T wave, spatial angle between QRS complex and T axis defined as the angle between the ventricular depolarization and repolarization vectors using maximal (QRSTP) and mean (QRSTM) vector amplitudes and spatial ventricular gradient (SVG) calculated as integral of ECG voltages over the entire QRST complex were analyzed. Additionally, we analyzed parameters of QT and heart rate variability using time and frequency domain.
Results:
At baseline, all analyzed parameters were comparable between both groups and heart rate remained constant. The intragroup analysis did not show any significant change in TpTe, QRSTP, QRSTM, SVG, QT, and heart rate variability at follow-up. Furthermore, intergroup comparison between CSR implantation and sham procedure also did not show any significant difference in the change of analyzed parameters.
Conclusions:
Compared to the sham procedure, CSR implantation did not demonstrate a significant impact on the arrhythmogenic substrate assessed with hrECG.
Clinical Trial Registration:
Unique Identifier: NCT04121845, https://classic.clinicaltrials.gov/ct2/show/NCT04121845.
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