Electrocardiographic Changes After Percutaneous Coronary Intervention for Chronic Total Occlusion

Area of Science:

• Cardiology
• Electrophysiology
• Interventional Cardiology

Background:

• The impact of successful percutaneous coronary intervention (PCI) on chronic total occlusion (CTO) on electrophysiologic parameters remains unclear.
• Assessing potential favorable electrophysiologic changes post-revascularization is crucial for understanding long-term outcomes.

Purpose of the Study:

• To investigate whether electrocardiogram (ECG) markers associated with arrhythmia risk are altered after successful CTO revascularization.
• To compare ECG changes in patients with successful versus unsuccessful CTO PCI.

Main Methods:

• Analysis of 10-second 12-lead ECG signals from patients undergoing CTO PCI between 2019 and 2023.
• Development of custom code to measure ECG parameters and assess changes pre- and post-PCI.
• Comparison of ECG markers between successful and unsuccessful revascularization groups, including repeat procedures.

Main Results:

• Out of 1520 CTO PCIs, 89.8% were successful. QT dispersion showed a statistically significant increase in unsuccessful cases compared to successful ones (p=0.0456).
• No significant differences in other arrhythmia risk markers were observed between successful and unsuccessful CTO PCI groups.
• A subset analysis of 55 patients indicated a different response in T-wave axis, but not QRS-T angle, following repeat PCI after an initial failed attempt (p=0.0307).

Conclusions:

• Successful CTO PCI is not associated with lasting changes in ECG features related to arrhythmia risk.
• Electrophysiologic effects of CTO revascularization appear minimal or transient based on ECG markers.