ST alternans can occur during coronary angioplasty without preceding premature ventricular contractions, a phenomenon potentially modified by calcium channel blocker use.
ST alternans without preceding ectopy during angioplasty should not alter management; single case leaves open its prognostic value and modification by calcium blockers.
Four patients with severe proximal or mid-LAD stenosis were noted to have ST alternans during balloon angioplasty. Neither mechanical alternans nor increased ventricular ectopy were noted. In contrast to prior descriptions in animals or patients with variant angina, ST alternans did not occur following a premature ventricular contraction. Frequent use of calcium channel blockers during PTCA may interfere with the mechanism leading to electrical alternans and its consequences as seen in animal studies, accounting for the low frequency with which this phenomenon is noted during PTCA.
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Sochanski et al. (1992) studied this question.
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