Transcoronary pacing to assess myocardial viability prior to percutaneous coronary intervention: Pilot study to assess feasibility

O’Neill, James; Hogarth, Andrew J.; Pearson, Ian; Law, Hannah; Bowes, Robert; Kidambi, Ananth; Wheatcroft, Stephen; Sivananthan, U.M.; Tayebjee, Muzahir H.

doi:10.1002/ccd.27349

Cited by 9 publications

(11 citation statements)

References 15 publications

(17 reference statements)

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“…An exchange length coronary guidewire (Asahi Sion Blue) was passed into both the target and reference coronary vessels to allow the use of either an over-the-wire balloon (Boston Scientific, US) or microcatheter, depending on procedure performed. The Sion Blue guidewire was used in each case to ensure consistency, as previous studies have shown different wires have different conduction properties [ 5 ], and our previous pilot study demonstrated adequate conduction with the Sion Blue [ 12 ], which is the most commonly used guidewire in our institution. Use of an over-the-wire balloon or microcatheter ensured electrical insulation of the guidewire, which cannot be achieved using monorail balloons.…”

Section: Methodsmentioning

confidence: 99%

“…Use of an over-the-wire balloon or microcatheter ensured electrical insulation of the guidewire, which cannot be achieved using monorail balloons. The distal tip of the guidewire was exposed beyond the balloon/microcatheter by one centimetre, to achieve adequate electrical contact, as used in our pilot study [ 12 ]. The proximal end of the guidewire was placed in its holder to maintain electrical insulation.…”

Section: Methodsmentioning

confidence: 99%

“…Our group have published a feasibility study for the use of TCP to establish electrophysiological parameters of myocardium during coronary intervention and compared these parameters to CMR assessment of viability. This study found that myocardial impedance and pacing thresholds were significantly different between normal myocardium and myocardium with >50% mural scar on CMR, with no significant difference seen in R wave amplitude for any of the assessed groups [ 12 ]. As this was a pilot study, more data were required before definitive conclusions could be made on the effectiveness of this novel viability assessment technique.…”

Section: Introductionmentioning

confidence: 99%

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Transcoronary electrophysiological parameters in patients undergoing elective and acute coronary intervention

et al. 2023

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Introduction Percutaneous coronary intervention is performed routinely in the management of myocardial infarction with obstructive coronary disease, but intervention to arteries supplying nonviable myocardium may be harmful. It is important therefore to establish myocardial viability, and there is an unmet need in current clinical practice for real time viability assessment to aid in decision making. Transcoronary pacing to assess myocardial electrophysiological parameters may be a novel viability assessment technique which could be used in this regard. Methods Coronary intervention was carried out according to standard departmental procedure with standard equipment. An exchange length coronary guidewire was passed into both target and reference coronary vessels and an over-the-wire balloon or microcatheter was used to insulate the guidewire and allow electrophysiological parameters to be assessed. Readings were obtained from all major epicardial vessels and substantial branches. At each position, an intracoronary electrocardiogram was recorded, and R wave amplitude was measured. Transcoronary pacing was then performed to establish threshold and impedance for each myocardial segment. A viability cardiac MRI scan was performed for each patient. A standard segmental model was used to determine viability in each segment using an ‘infarct score’ based on degree of late gadolinium enhancement. Studies were reported blinded to the electrical parameters obtained from the coronary guidewire. The primary outcome was the relationship between pacing threshold and myocardial segment infarct score. Secondary outcomes included the relationship between segmental infarct score and R wave height, and between segmental infarct score and pacing impedance. Data were collected on the feasibility of studying the coronary segments as well as safety. Results Sixty-five patients presenting with stable coronary artery disease or acute coronary syndromes to Leeds General Infirmary between September 2019 and August 2021 were included in the study. Electrophysiological parameters from segments with an infarct score of zero were obtained, with wide variances seen, with no significant difference in impedance or threshold in any territory. There was a significant difference in sensitivity for segments in the right coronary artery territory for both elective and acute patients. This likely relates to reduced myocardial mass in these territories. No significant association between infarct score and sensitivity, impedance or threshold were seen. Conclusion This study has established intracoronary electrophysiological parameters in both normal myocardium and areas of myocardial scar. No reliable association was seen between impedance, threshold or R wave amplitude and degree of myocardial viability, contrasting with prior findings from our group and others. More work is therefore required to fully understand the role of transcoronary pacing in this setting.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transcoronary electrophysiological parameters in patients undergoing elective and acute coronary intervention

et al. 2023

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“…Novel physiological markers, such as the index of microcirculatory resistance (IMR) and wave intensity analysis (WIA) offer the opportunity to simultaneously assess myocardial physiology, but at present are restricted to research environments [ 39 •, 40 ]. Very early data suggest invasive electro-anatomic indices, such as voltage mapping, also merit exploration [ 41 , 42 ].…”

Section: Introductionmentioning

confidence: 99%

Identifying and Managing Hibernating Myocardium: What’s New and What Remains Unknown?

Ryan

Perera

2018

Curr Heart Fail Rep

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Purpose of ReviewHibernation is an important and reversible cause of myocardial dysfunction in ischaemic heart failure.Recent FindingsHibernation is an adaptive process that promotes myocyte survival over maintaining contractile function. It is innate to mammalian physiology, sharing features with physiological hibernation in other species. Advanced imaging methods have reasonable accuracy in identifying hibernating myocardium. Novel superior hybrid methods may provide diagnostic potential. New evidence supports the role of surgical revascularisation in ischaemic heart failure, but the role of viability tests in planning such procedures remains unclear. Research to date has exclusively involved patients with ambulatory heart failure: Investigating the role of hibernation in ADHF is a key avenue for the future.SummaryWhilst our understanding of hibernation pathophysiology has improved dramatically, the clinical utility of identifying and targeting hibernation remains unclear.

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“…O'Neil and colleagues present a pilot study of transcoronary pacing (TCP) to identify electrical parameters of viability The modality is appealing for its simplicity and ease, requiring only standard equipment typically available in the catheterization laboratory. Briefly, an exchange‐length 0.014″ coronary wire is placed in various coronary beds with an over‐the‐wire balloon acting as an insulator.…”

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confidence: 99%

Transcoronary pacing threshold predicts myocardial scar: Novel first‐step towards intraprocedural myocardial functional assessment

Nakamura

Dean

2018

Cathet Cardio Intervent

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Key Points Transcoronary pacing (TCP) is a novel modality to assess the subtended myocardium during percutaneous coronary intervention (PCI). In a proof‐of‐concept trial of six patients, TCP threshold discriminated scar from normal myocardium in the left anterior descending coronary distribution. Further investigation is needed to determine whether TCP can assess myocardial viability to inform intraprocedural decision making.

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Transcoronary pacing to assess myocardial viability prior to percutaneous coronary intervention: Pilot study to assess feasibility

Abstract: Impedance and pacing threshold, measured during TCP, can be used to differentiate between normal myocardium and scarred myocardium. Further research is needed to determine whether TCP can discriminate between viable and nonviable myocardium.

Cited by 9 publications

References 15 publications

Transcoronary electrophysiological parameters in patients undergoing elective and acute coronary intervention

Transcoronary electrophysiological parameters in patients undergoing elective and acute coronary intervention

Identifying and Managing Hibernating Myocardium: What’s New and What Remains Unknown?

Transcoronary pacing threshold predicts myocardial scar: Novel first‐step towards intraprocedural myocardial functional assessment

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