Electrocardiography Predictive Value on Coronary Slow Flow Phenomenon

Coronary Slow Flow Phenomenon (CSFP) is characterized by the slow flow of contrast in one or more epicardial coronary vessels without evidence of coronary artery stenosis during coronary angiography procedures. CSFP is fairly common at the time of elective angiography with an incidence of around 7% and accounts for about 4% of hospitalized unstable angina cases. Coronary angiography is currently still the only effective way to detect CSFP, but this procedure is an invasive procedure with high costs, there is a risk of allergy to contrast. Electrocardiography (ECG), as a widely available, inexpensive, and simple modality is felt to be an attractive alternative in early detection of this abnormality. The ECG parameters on CSFP discussed in this study include; p-wave dispersion, QT interval dispersion, QRS intrinsic (Tpeak-Tenddeflection duration), and QRS fragmentation. Further studies are needed on the ECG image in CSFP so that in the future ECG can be a cheaper and non-invasive diagnostic modality for CSFP compared to coronary angiography.

The effect of recanalization of a chronic total coronary occlusion on P-wave dispersion

Introduction: P-wave dispersion (PWD) obtained from the standard 12-lead electrocardiography (ECG) is considered to reflect the homogeneity of the atrial electrical activity. The aim of this investigation was to evaluate the effect of percutaneous chronic total occlusion (CTO) revascularization on the parameters of P wave duration and PWD on ECG in cases before and after procedure at 12th months. Methods: We analyzed 90 consecutive CTO cases who were on sinus rhythm and underwent percutaneous coronary intervention (PCI). P-wave maximum (P-max) and P-wave minimum (P-min), P-wave time, and PWD were determined before and twelve months after the CTO intervention. The study population was categorized into two groups as successful and unsuccessful CTO PCI groups. Results: The CTO PCI was successful in 71% of cases (n=64) and it was unsuccessful in 29% of cases (n=26). Both groups, except for age and hypertension, were similar in terms of demographic and clinical aspects. CRP levels were significantly elevated in the unsuccessful CTO PCI group. Pre-PCI ECG parameters showed no significant difference. Irrespective of the target vessel revascularization, we observed that PWD and P-max values were significantly lower in the 12th months follow-up. In all Rentrop classes, PWD values were significantly decreased at 12th months follow-up in comparison to the pre-CTO PCI values. Conclusion: This study has determined that PWD and P-max, which are both risk factors for atrial arrhythmias, are significantly reduced within 12th months after successful CTO PCI regardless of the target vessel.

Association of P wave Dispersion with Angiographic Severity in Patients with Chronic Stable Angina

Background:Stable angina forms a significant proportion of coronary artery disease. Newer non-invasive modalities with good predictive values like CT coronary angiography and myocardial perfusion imaging are available, they are not feasible for widespread use. In this scenario, we can use the ECG parameter (P wave dispersion) as a non-invasive, efficient and cost-effective tool for diagnosing coronary artery stenosis in chronic stable angina. Objective: To find out the association between P wave dispersion in electrocardiogram and angiographic findings by coronary angiogram in patients with chronic stable angina. Methods: This cross sectional study was conducted at the Department of Cardiology, Bangabandhu Sheikh Mujib Medical University, Dhaka from July 2018 to June 2019.Patients with chronic stable angina who were undergoing invasive coronary angiography was included in this study. A total of 45 patients were included in the study. Immediately after admission, standard 12 lead ECG was recorded at a 50 mm/s paper speed and a gain of 10 mm/mV. P wave dispersion are calculated from the standard ECG during sinus rhythm in any of the 12 ECG leads. Finally, all the enrolled patients underwent invasive evaluation by coronary angiography. The severity of CAD was assessed by Gensini score. Results:The mean PD was 23.3±8.1 millisecond in patients without CAD, 37.1±7.6 millisecond in single vessel disease, 45.3±9.1 millisecond in double vessel disease and 45.9±9.4 millisecond in triple vessel disease, which were statistically significant (p<0.05) among four groups.There was a significant correlation of PD (P wave dispersion) with Gensini score (r=0.631; p=0.001). Conclusion: This study demonstrates that there is a significant association of PD (P wave dispersion) with the severity of coronary artery disease in patients with chronic stable angina. University Heart Journal Vol. 17, No. 2, Jul 2021; 81-85