Electrophysiological Effects of Selective Atrial Coronary Artery Occlusion in Humans
Background—The arrhythmogenesis of ventricular myocardial ischemia has been extensively studied, but models of atrial ischemia in humans are lacking. This study aimed at describing the electrophysiological alterations induced by acute atrial ischemia secondary to atrial coronary branch occlusion during elective coronary angioplasty.
Methods and Results—Clinical data, 12-lead ECG, 12-hours Holter recordings, coronary angiography, and serial plasma levels of high sensitivity troponin T and mid-regional proatrial natriuretic peptide were prospectively analyzed in 109 patients undergoing elective angioplasty of right or circumflex coronary arteries. Atrial coronary branches were identified and after the procedure patients were allocated into two groups: atrial branch occlusion (ABO, n=17) and atrial branch patency (non-ABO, n=92). As compared with the non-ABO, patients with ABO showed: a) higher incidence of periprocedural myocardial infarction (20% vs. 53%, p= 0.01); b) more frequent intra-atrial conduction delay (19% vs. 46%, p=0.03); c) more marked PR segment deviation in the Holter recordings; and d) higher incidence of atrial tachycardia (15% vs. 41%, p=0.02) and atrial fibrillation (0% vs. 12%, p=0.03). After adjustment by a propensity score, ABO was an independent predictor of periprocedural infarction (OR 3.4, CI 1.01-11.6, p<0.05) and atrial arrhythmias (OR 5.1, CI 1.2-20.5, p=0.02).
Conclusions—Selective atrial coronary artery occlusion during elective PTCA is associated with myocardial ischemic damage, atrial arrhythmias, and intra-atrial conduction delay. Our data suggest that atrial ischemic episodes might be considered as a potential cause of atrial fibrillation in patients with chronic coronary artery disease.
- PR segment deviation
- Intra-atrial conduction delay
- atrial coronary branch occlusion
- percutaneous coronary intervention
- atrial fibrillation
- periprocedural myocardial infarction
- Received January 27, 2016.
- Revision received April 15, 2016.
- Accepted April 20, 2016.