International Journal of Biomedicine. 2023;13(3):59-65.
Originally published September 5, 2023
Background: An attempt was made to study the effect of surgical myocardial revascularization on the processes of electrical myocardium instability underlying the occurrence of life-threatening ventricular arrhythmias, as well as the possibility of its non-invasive assessment by studying heart rate variability (HRV) and heart rate turbulence (HRT), as well as the duration and dispersion of the QT interval. Based only on the presence of viable myocardium, it is often impossible to predict the positive impact of revascularization on a patient’s prognosis, especially with reduced myocardial contractility. Moreover, given the well-studied relationship between myocardial remodeling and neurohormonal activation, non-invasive methods for assessing the autonomic regulation of cardiac activity can provide additional diagnostic information. Along with this, changes in these indicators and their prognostic role in patients with coronary artery disease after revascularization are subjects of discussion.
Methods and Results: All patients underwent a comprehensive clinical and biochemical blood test, transthoracic echocardiography, tissue Doppler echocardiography, ultrasound examination of brachiocephalic arteries, selective coronary angio- and ventriculography, as well as Holter monitoring. Results show that a year after the coronary intervention, there was a significant positive trend in the frequency and structure of ventricular arrhythmias (VA). HRV indicators generally did not show significant dynamics. Only an increase in the values of the SDANN and low-frequency power (LFP) indices was noted, indicating a gradual increase in the activity of the sympathetic part of the autonomic nervous system. HRT indicators also did not show significant dynamics. A significant increase was found in the number of patients with no signs of impaired HRT. The average duration of the QT interval decreased significantly. There was also a tendency to shorten the corrected QT interval; however, it was insignificant. In terms of dispersion, both the QT interval and its corrected index, no significant dynamics were recorded in the general group of patients.
Conclusion: Our study found that in patients with prior myocardial infarction, after revascularization, significant positive dynamics were recorded in life-threatening ventricular arrhythmias, but were unreliable for the indicators of autonomic regulation of cardiac activity, such as HRV and HRT.
- Velazquez EJ, Lee KL, Jones RH, Al-Khalidi HR, Hill JA, Panza JA, et al.; STICHES Investigators. Coronary-Artery Bypass Surgery in Patients with Ischemic Cardiomyopathy. N Engl J Med. 2016 Apr 21;374(16):1511-20. doi: 10.1056/NEJMoa1602001.
- Kolh P, Kurlansky P, Cremer J, Lawton J, Siepe M, Fremes S. Transatlantic Editorial: A Comparison Between European and North American Guidelines on Myocardial Revascularization. Ann Thorac Surg. 2016 Jun;101(6):2031-44. doi: 10.1016/j.athoracsur.2016.02.062.
- Jiang L, Xu L, Song L, Gao Z, Tian J, Sun K, Yu H, Xu B, Song L, Yuan J. Comparison of three treatment strategies for patients with triple-vessel coronary disease and left ventricular dysfunction. J Interv Cardiol. 2018 Jun;31(3):310-318. doi: 10.1111/joic.12497.
- Park SJ, Ahn JM, Kim YH, Park DW, Yun SC, Lee JY, et al.; BEST Trial Investigators. Trial of everolimus-eluting stents or bypass surgery for coronary disease. N Engl J Med. 2015 Mar 26;372(13):1204-12. doi: 10.1056/NEJMoa1415447.
- Gallo M, Blitzer D, Laforgia PL, Doulamis IP, Perrin N, Bortolussi G, Guariento A, Putzu A. Percutaneous coronary intervention versus coronary artery bypass graft for left main coronary artery disease: A meta-analysis. J Thorac Cardiovasc Surg. 2022 Jan;163(1):94-105.e15. doi: 10.1016/j.jtcvs.2020.04.010.
- Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, Ståhle E, Feldman TE, van den Brand M, Bass EJ, Van Dyck N, Leadley K, Dawkins KD, Mohr FW; SYNTAX Investigators. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009 Mar 5;360(10):961-72. doi: 10.1056/NEJMoa0804626.
- Andersen JA, Freeman P, Larsen JM, Andersen NH. Monomorphic ventricular tachycardia as the primary presentation of an anterior STEMI. Clin Case Rep. 2019 Jul 26;7(9):1680-1684. doi: 10.1002/ccr3.2324.
- Marrakchi S, Laroussi L, Bennour E, Kammoun I, Kachboura S. Coronary PCI revascularization novel treatment of bundle branch reentrant ventricular tachycardia. J Cardiol Cases. 2019 Sep 20;20(5):151-154. doi: 10.1016/j.jccase.2019.08.003.
- Gatzoulis KA, Tsiachris D, Arsenos P, Antoniou CK, Dilaveris P, Sideris S, et al. Arrhythmic risk stratification in post-myocardial infarction patients with preserved ejection fraction: the PRESERVE EF study. Eur Heart J. 2019 Sep 14;40(35):2940-2949. doi: 10.1093/eurheartj/ehz260.
- Bui AH, Waks JW. Risk Stratification of Sudden Cardiac Death After Acute Myocardial Infarction. J Innov Card Rhythm Manag. 2018 Feb 15;9(2):3035-3049. doi: 10.19102/icrm.2018.090201.
- Lown B, Wolf M. Approaches to sudden death from coronary heart disease. Circulation. 1971 Jul;44(1):130-42. doi: 10.1161/01.cir.44.1.130.
- Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, et al. 2015 ESC Guidelines for the Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. Rev Esp Cardiol (Engl Ed). 2016 Feb;69(2):176. doi: 10.1016/j.rec.2016.01.001.
- Furukawa T, Moroe K, Mayrovitz HN, Sampsell R, Furukawa N, Myerburg RJ. Arrhythmogenic effects of graded coronary blood flow reductions superimposed on prior myocardial infarction in dogs. Circulation. 1991 Jul;84(1):368-77. doi: 10.1161/01.cir.84.1.368.
- Kimura S, Bassett AL, Cameron JS, Huikuri H, Kozlovskis PL, Myerburg RJ. Cellular electrophysiological changes during ischemia in isolated, coronary-perfused cat ventricle with healed myocardial infarction. Circulation. 1988 Aug;78(2):401-6. doi: 10.1161/01.cir.78.2.401.
- Rizzello V, Poldermans D, Boersma E, Biagini E, Schinkel AF, Krenning B, Elhendy A, Vourvouri EC, Sozzi FB, Maat A, Crea F, Roelandt JR, Bax JJ. Opposite patterns of left ventricular remodeling after coronary revascularization in patients with ischemic cardiomyopathy: role of myocardial viability. Circulation. 2004 Oct 19;110(16):2383-8. doi: 10.1161/01.CIR.0000145115.29952.14.
- Saidova MA, Belenkov IuN, Akchurin RS, Sergienko VB, Khodareva EN, Kostrova VV. [Viable myocardium: comparative evaluation of surgical and pharmacological treatment of patients with ischemic heart disease, post-infarct cardiosclerosis and chronic cardiac failure]. Ter Arkh. 2002;74(2):60-4. [Article in Russian].
- Schinkel AF, Poldermans D, Rizzello V, Vanoverschelde JL, Elhendy A, Boersma E, Roelandt JR, Bax JJ. Why do patients with ischemic cardiomyopathy and a substantial amount of viable myocardium not always recover in function after revascularization? J Thorac Cardiovasc Surg. 2004 Feb;127(2):385-90. doi: 10.1016/j.jtcvs.2003.08.005.
- Bonow RO, Maurer G, Lee KL, Holly TA, Binkley PF, Desvigne-Nickens P, et al.; STICH Trial Investigators. Myocardial viability and survival in ischemic left ventricular dysfunction. N Engl J Med. 2011 Apr 28;364(17):1617-25. doi: 10.1056/NEJMoa1100358.
- Huikuri HV, Valkama JO, Airaksinen KE, Seppänen T, Kessler KM, Takkunen JT, Myerburg RJ. Frequency domain measures of heart rate variability before the onset of nonsustained and sustained ventricular tachycardia in patients with coronary artery disease. Circulation. 1993 Apr;87(4):1220-8. doi: 10.1161/01.cir.87.4.1220.
- Huikuri HV, Stein PK. Clinical application of heart rate variability after acute myocardial infarction. Front Physiol. 2012 Feb 27;3:41. doi: 10.3389/fphys.2012.00041.
- Bigger JT Jr, Fleiss JL, Steinman RC, Rolnitzky LM, Kleiger RE, Rottman JN. Correlations among time and frequency domain measures of heart period variability two weeks after acute myocardial infarction. Am J Cardiol. 1992 Apr 1;69(9):891-8. doi: 10.1016/0002-9149(92)90788-z.
- Kleiger RE, Miller JP, Bigger JT Jr, Moss AJ. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol. 1987 Feb 1;59(4):256-62. doi: 10.1016/0002-9149(87)90795-8.
- Tsuji H, Larson MG, Venditti FJ Jr, Manders ES, Evans JC, Feldman CL, Levy D. Impact of reduced heart rate variability on risk for cardiac events. The Framingham Heart Study. Circulation. 1996 Dec 1;94(11):2850-5. doi: 10.1161/01.cir.94.11.2850.
- Lakusic N, Mahovic D, Sonicki Z, Slivnjak V, Baborski F. Outcome of patients with normal and decreased heart rate variability after coronary artery bypass grafting surgery. Int J Cardiol. 2013 Jun 20;166(2):516-8. doi: 10.1016/j.ijcard.2012.04.040.
- Cygankiewicz I, Zareba W, Vazquez R, Vallverdu M, Cino J, Cinca J, et al. Relation of heart rate turbulence to severity of heart failure. Am J Cardiol. 2006 Dec 15;98(12):1635-40. doi: 10.1016/j.amjcard.2006.07.042.
- Mäkikallio TH, Barthel P, Schneider R, Bauer A, Tapanainen JM, Tulppo MP, Schmidt G, Huikuri HV. Prediction of sudden cardiac death after acute myocardial infarction: role of Holter monitoring in the modern treatment era. Eur Heart J. 2005 Apr;26(8):762-9. doi: 10.1093/eurheartj/ehi188.
- Cygankiewicz I, Wranicz JK, Bolinska H, Zaslonka J, Jaszewski R, Zareba W. Prognostic significance of heart rate turbulence in patients undergoing coronary artery bypass grafting. Am J Cardiol. 2003 Jun 15;91(12):1471-4, A8. doi: 10.1016/s0002-9149(03)00402-8.
Received May 2, 2023.
Accepted June 18, 2023.
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