Vulnerability for Ventricular Arrhythmias in Patients with Chronic Coronary Total Occlusion.

Vulnerability for Ventricular Arrhythmias in Patients with Chronic Coronary Total Occlusion.
Expert Rev Cardiovasc Ther. 2020 Jul 20;:
Authors: Assaf A, Diletti R, Hoogendijk MG, van der Graaf M, Zijlstra F, Szili-Torok T, Yap SC
Abstract
INTRODUCTION: The presence of a chronic total occlusion (CTO) is associated with an increased risk of ventricular arrhythmias.
AREAS COVERED: This review provides an overview of the relationship between CTO and ventricular arrhythmias, arrhythmogenic mechanisms, and the effect of revascularization.
EXPERT OPINION: Studies in recipients of an implantable cardioverter-defibrillator (ICD) have shown that a CTO is an independent predictor of appropriate ICD therapy. The myocardial territory supplied by a CTO is a pro-arrhythmogenic milieu characterized by scar tissue, large scar border zone, hibernating myocardium, residual ischemia despite collaterals, areas of slow conduction, and heterogeneity in repolarization. Restoring coronary flow by revascularization might be associated with electrical homogenization as reflected by a decrease in QT(c) dispersion, decrease in T wave peak-to-end interval, reduction of late potentials, and decrease in scar border zone area. Future research should explore whether CTO revascularization results in a lower burden of ventricular arrhythmias. Furthermore, risk stratification of CTO patients without severe LV dysfunction is interesting to identify potent...

Source: Expert Review of Cardiovascular Therapy - July 22, 2020 Category: Cardiology Tags: Expert Rev Cardiovasc Ther Source Type: research