The Evaluation of Lesion Localization and Ischemic Myocardial Mass Via Arrhythmia Parameters in Stable Coronary Artery Patients with Myocardial Ischemia

The aim of this study was to evaluate which critical coronary artery stenosis is more arrhythmogenic in stable coronary artery disease and whether the involved stenotic artery or the size of the myocardial tissue under ischemia due to stenosis is more important in terms of malignant ventricular arrhythmias by using arrhythmia predictors calculated on electrocardiography. This was a retrospective observational study. We scanned patients who underwent percutaneous coronary intervention for single vessel stable coronary artery disease between January 2013 and 2016. Assigned indicators of increased arrhythmogenic risk as TpTe interval, QTc interval and TpTe/QT ratio were calculated on electrocardiography before and after the percutaneous coronary intervention. We also calculated the anatomical myocardial area at risk of ischemia as a percentage of the left ventricular myocardium volume for a given site of lesion with APPROACH score by assessing coronary angiography images. The percentage of left ventricular jeopardized myocardium in left anterior descending artery lesions (34±10) was significantly higher than those in circumflex artery (17±11) and right coronary artery (21±5) lesions (p<0.001). Furthermore, the differences between TpTe intervals and TpTe/QT ratios measured before and after the percutaneous coronary intervention were significantly higher in patients with left anterior descending artery lesions than patients with circumflex artery and right coronary artery lesions (p<0.001). In patients with stable coronary artery disease, the size of the ischemic myocardium was associated with increased arrhythmogenesis. Patients with left anterior descending artery lesions may get the greatest benefit from revascularization in terms of arrhythmia predictors calculated on electrocardiography.