Intracoronary ST-segment Alternans during Coronary Balloon Angioplasty.

Abstract

SUMMARYST-segment alternans has been described in experimental coronary artery occlusion and in patients with variant angina. It is also seen during coronary angioplasty. This report describes a patient who on balloon inflation during coronary angioplasty demonstrated ST-segment alternans only on intracoronary electrocardiogram but did not on surface 12 lead electrocardiogram. Hemodynamic pulsus alternans of the aortic pressure tracing was not observed during electrical alternans. (Jpn Heart J 1998; 39: 221-224) induced myocardial ischemia in experimental animals1,3) and in man during exercise,4) Prinzmetal's angina5,6) and coronary angioplasty.7-9) Whereas ST-segment shifts (particularly ST-segment elevation) are frequent during angioplasty,10) STsegment alternans is infrequent.11) We present a patient who on balloon inflation during coronary angioplasty demonstrated ST alternans recorded only by intracoronary electrocardiogram but not by surface 12 lead electrocardiogram. CASE REPORTA 40-year-old male with unstable angina was admitted to the CCU. Emergency coronary arteriography was carried out and emergency PTCA was then performed on the 90% stenotic lesion of the proximal portion of the left anterior descending artery (LAD). There was no collateral flow to the LAD from the

The Intracoronary Electrocardiogram in Percutaneous Coronary Intervention

“…T‐wave alternans is an umbrella term referring to alternation of the ECG ST‐segment, T or U wave, and has been shown to be useful in predicting future arrhythmia risk 18 . ST‐alternans occurs during a proportion of coronary angioplasty procedures, and there is modest evidence that the IC‐ECG is more sensitive at detecting ST‐alternans than the S‐ECG 19–21 . ST‐alternans on IC‐ECG was shown to identify a large area of myocardial ischemia, 22 is associated with the occurrence of ventricular arrhythmias during angioplasty, 19 and may be abolished by preconditioning 21 .…”

“…18 ST-alternans occurs during a proportion of coronary angioplasty procedures, and there is modest evidence that the IC-ECG is more sensitive at detecting ST-alternans than the S-ECG. [19][20][21] ST-alternans on IC-ECG was shown to identify a large area of myocardial ischemia, 22 is associated with the occurrence of ventricular arrhythmias during angioplasty, 19 and may be abolished by preconditioning. 21 It is possible that persisting ST-alternans on IC-ECG could identify patients with unrecognized ongoing ischemia or patients requiring more intensive postprocedural monitoring.…”