Beyond A and B: Exploring a Novel dynamic ECG change in Wellens Syndrome

Area of Science:

• Cardiology
• Electrocardiography
• Ischemic Heart Disease

Background:

• Wellens syndrome presents with high-risk ECG patterns linked to critical left anterior descending artery (LAD) stenosis.
• Pattern A is often underdiagnosed, with Pattern B being more common in emergency presentations, suggesting Pattern A evolves earlier.
• A dynamic model proposing ECG transitions between Wellens' patterns A and B is suggested.

Purpose of the Study:

• To investigate serial electrocardiographic (ECG) changes and transitions in patients with Wellens syndrome.
• To analyze the relationship between ECG patterns, clinical factors, and outcomes in Wellens syndrome.
• To support a dynamic model of Wellens syndrome ECG evolution.

Main Methods:

• Enrolled 51 patients diagnosed with Wellens syndrome.
• Assessed serial ECG changes, demographic data, cardiovascular risk factors, and clinical history.
• Coronary angiography was performed to confirm LAD involvement; revascularization outcomes were analyzed.

Main Results:

• Coronary angiography confirmed LAD involvement in all patients.
• An ECG transition from Wellens' pattern A to pattern B was observed within 6 to 12 hours in 18 patients (36%).
• All patients in the cohort experienced favorable clinical outcomes.

Conclusions:

• Wellens syndrome may exhibit a dynamic ECG transition between patterns A and B, explained by shifting ischemic vectors.
• The observed ECG transition occurred in a significant portion of patients, supporting the dynamic model.
• Patients with Wellens syndrome in this cohort achieved favorable outcomes, regardless of the specific ECG pattern evolution.