AI Article Synopsis

  • Successful recanalization of chronic total occlusions (CTOs) in patients is linked to better clinical outcomes, possibly due to reduced arrhythmias from changes in the heart muscle (myocardium) in affected areas.
  • A systematic review and meta-analysis of eight studies with 467 patients were conducted, revealing significant decreases in specific ECG parameters (QT dispersion, QTc dispersion, and Tp-e intervals) after successful CTO percutaneous coronary intervention (PCI).
  • The findings suggest that successful CTO PCI improves heart electrical activity, potentially lowering the risk of dangerous heart rhythms and sudden cardiac death, challenging the notion that the affected heart muscle is entirely inactive.

Article Abstract

Background: Observational studies suggest that in patients with a CTO successful recanalization is associated with better clinical outcome. This could be related to a reduction in the occurrence of arrhythmias, which may result from modifications of the hibernating myocardium in a CTO region.

Methods And Results: We aimed to evaluate the effect of CTO PCI on electrophysiological parameters, and conducted a systematic review and meta-analysis according to the PRISMA guidelines. MEDLINE and EMBASE were searched. Titles and abstracts identified by the search strategy were independently screened by two investigators. Data were extracted and used for meta-analyses where possible. In total, eight studies incorporating 467 patients were included in this review, evaluating the effect of successful CTO PCI on various ECG parameters. Three studies showed a significant decrease in mean QT dispersion of 17.46ms [95% CI 10.62-24.30] after successful CTO PCI. QTc dispersion also decreased significantly, with a mean decrease of 18.74ms [95% CI 11.53-25.94]. In one trial a significant decrease in Tp-e interval in leads V2 and V5, and a significant decrease in Tp-e/QT ratio in leads V2 and V5 post-CTO PCI were observed.

Conclusions: This first systematic review and meta-analysis suggests that successful CTO PCI is associated with an immediate decrease in ECG parameters that reflect heterogeneity in depolarization and repolarization, which could lead to a reduction in the risk for ventricular arrhythmias and sudden cardiac death. We raise the hypothesis that hibernating myocardium in a CTO region may not be as deeply "in sleep" as one would assume.

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http://dx.doi.org/10.1016/j.carrev.2017.09.004DOI Listing

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