Key result
Successful recanalization of chronic total occlusion significantly decreased the left ventricular border zone area by a median of 10.5 cm2 and increased the preserved voltage area by 19.2 cm2.
Why the study?
Successful PCI for CTO reduces cardiac mortality and fatal ventricular arrhythmias, but its effect on endocardial left ventricular voltages needed evaluation via paired electrophysiological studies.
Does recanalization of chronic total occlusion improve endocardial left ventricular voltages in patients with de novo CTO lesions?
Cohort (n=16)
No
Does recanalization of chronic total occlusion improve endocardial left ventricular voltages in patients with de novo CTO lesions?
Mean Difference: -10.5 (95% CI -16.8–-4.1)
Absolute Event Rate: -10.5% vs 5.3%
p-value: p=0.004
Successful PCI for chronic total occlusion promotes reverse electrical remodeling in the left ventricular border zone, providing a potential mechanism for reduced ventricular arrhythmias.
May support electrical remodeling post-CTO PCI as arrhythmia mechanism; hypothesis-generating and should not yet change practice.
Background Successful percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) is associated with reduction of cardiac mortality, as well as reducing fatal ventricular arrhythmias. The aim of this study was to evaluate the effect of recanalization of CTO on endocardial left ventricular voltages by paired electrophysiological studies. Methods Sixteen consecutive patients who underwent PCI for de novo CTO lesions were included. High‐density mapping was performed during sinus rhythm before and 8 months after PCI. According to the amplitude of bipolar electrograms, the left ventricular endocardium was classified into a preserved normal voltage (>1.5 mV), border zone (0.5–1.5 mV), and dense scar areas (<0.5 mV). Results The border zone area had a significant positive correlation with CTO length, as well as a significant negative correlation observed in the preserved voltage region. In the successful PCI patient, the median dense scar area did not change significantly (reported as [median difference: 95% confidence interval]) between baseline and after PCI (0.1 cm2: –2.8 to 2.9). However, the area of the border zone decreased (–10.5 cm2: –16.8 to –4.1) and the preserved voltage area increased significantly (19.2 cm2: 7.7–30.6). In addition, successful PCI was related to slight, but significant, increase in the amplitude of unipolar and bipolar voltage (1.55 mV: 0.88–3.33, 0.23 mV: 0.08–0.36). Conclusions Recanalization of CTO may promote reverse electrical remodeling in the border zone of the left ventricle, without affecting the dense scar tissue.
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Yamashita et al. (2019) conducted a cohort in Chronic total occlusion (CTO) of native coronary artery (n=16). Successful recanalization of CTO (PCI) vs. Unsuccessful PCI or reocclusion was evaluated on Change in left ventricular border zone area (0.5-1.5 mV) (median difference -10.5 cm2, 95% CI -16.8 to -4.1, p=0.004). Successful recanalization of chronic total occlusion significantly decreased the left ventricular border zone area by a median of 10.5 cm2 and increased the preserved voltage area by 19.2 cm2.
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