Coronary Artery Anatomical Variations and Palpitations in Libyan Adults Undergoing Coronary Imaging: A Multicentre Retrospective Study

Background: Coronary artery anatomical variations comprise a heterogeneous spectrum of structural configurations involving coronary origin, ostial anatomy, branching, course, and vessel morphology. Although palpitations are reported in patients with selected coronary anomalies, comparative evidence quantifying whether this symptom is more frequent in adults with versus without documented coronary anatomical variation remains limited, particularly in North African clinical cohorts. This study examined and quantified the association between documented coronary anatomical variation and palpitations in a multicentre Libyan coronary-imaging cohort.Methods: This multicentre retrospective cross-sectional study included 200 adults evaluated at three Libyan cardiac centres. Coronary anatomical variation status and palpitations were obtained from imaging and clinical records. Participants were classified by presence or absence of any documented coronary anatomical variation. Pearson's chi-square test assessed the association with palpitations, and Cramer's V quantified its strength.Results: Coronary anatomical variation was documented in 87 of 200 participants (43.5%). Palpitations occurred in 17/87 (19.5%) with variation versus 10/113 (8.8%) without (χ²(1)=4.811, p=0.028; Cramer's V=0.155). The unadjusted odds ratio was 2.50 (95% CI 1.08–5.79) and the prevalence ratio was 2.21 (95% CI 1.06–4.58).Conclusions: In this multicentre Libyan coronary-imaging cohort, documented palpitations were more frequent among adults with coronary anatomical variation than among those without documented variation. This study provides a direct quantitative comparison of documented palpitations between Libyan adults with and without coronary anatomical variation, rather than describing symptom prevalence among anomaly cases alone; nevertheless, the small effect size, limited number of events, and cross-sectional design preclude causal or electrophysiological inference. Prospective phenotype-specific studies incorporating objective rhythm monitoring are warranted.