title: Electrophysiological Effects of Selective Atrial Coronary Artery Occlusion in Humans.
abstract: The arrhythmogenesis of ventricular myocardial ischemia has been extensively studied, but models of atrial ischemia in humans are lacking. This study aimed at describing the electrophysiological alterations induced by acute atrial ischemia secondary to atrial coronary branch occlusion during elective coronary angioplasty.
  
  
  
  Clinical data, 12-lead ECG, 12-hour Holter recordings, coronary angiography, and serial plasma levels of high-sensitivity troponin T and midregional proatrial natriuretic peptide were prospectively analyzed in 109 patients undergoing elective angioplasty of right or circumflex coronary arteries. Atrial coronary branches were identified and after the procedure patients were allocated into two groups: atrial branch occlusion (ABO, n=17) and atrial branch patency (non-ABO, n=92). In comparison with the non-ABO, patients with ABO showed: (1) higher incidence of periprocedural myocardial infarction (20% versus 53%, P=0.01); (2) more frequent intra-atrial conduction delay (19% versus 46%, P=0.03); (3) more marked PR segment deviation in the Holter recordings; and (4) higher incidence of atrial tachycardia (15% versus 41%, P=0.02) and atrial fibrillation (0% versus 12%, P=0.03). After adjustment by a propensity score, ABO was an independent predictor of periprocedural infarction (odds ratio, 3.4; 95% confidence interval, 1.01-11.6, P<0.05) and atrial arrhythmias (odds ratio, 5.1; 95% confidence interval, 1.2-20.5, P=0.02).
  
  
  
  Selective atrial coronary artery occlusion during elective percutaneous transluminal coronary angioplasty is associated with myocardial ischemic damage, atrial arrhythmias, and intra-atrial conduction delay. Our data suggest that atrial ischemic episodes might be considered as a potential cause of atrial fibrillation in patients with chronic coronary artery disease.
authors.affiliation: From Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Spain (J.A.-G., M.V.-B., A.F.-G., A.S.-P., J.C.); Department ESAII, EUETIB, Universidad Politécnica de Cataluña, Barcelona, Spain (P.G.); and Biochemistry and Molecular Biology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Spain (J.O.-L.). jalvarezg@santpau.cat.
authors.forename: Jesús
authors.initials: J
authors.lastname: Álvarez-García
authors.affiliation: From Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Spain (J.A.-G., M.V.-B., A.F.-G., A.S.-P., J.C.); Department ESAII, EUETIB, Universidad Politécnica de Cataluña, Barcelona, Spain (P.G.); and Biochemistry and Molecular Biology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Spain (J.O.-L.).
authors.forename: Miquel
authors.initials: M
authors.lastname: Vives-Borrás
authors.affiliation: From Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Spain (J.A.-G., M.V.-B., A.F.-G., A.S.-P., J.C.); Department ESAII, EUETIB, Universidad Politécnica de Cataluña, Barcelona, Spain (P.G.); and Biochemistry and Molecular Biology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Spain (J.O.-L.).
authors.forename: Pedro
authors.initials: P
authors.lastname: Gomis
authors.affiliation: From Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Spain (J.A.-G., M.V.-B., A.F.-G., A.S.-P., J.C.); Department ESAII, EUETIB, Universidad Politécnica de Cataluña, Barcelona, Spain (P.G.); and Biochemistry and Molecular Biology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Spain (J.O.-L.).
authors.forename: Jordi
authors.initials: J
authors.lastname: Ordoñez-Llanos
authors.affiliation: From Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Spain (J.A.-G., M.V.-B., A.F.-G., A.S.-P., J.C.); Department ESAII, EUETIB, Universidad Politécnica de Cataluña, Barcelona, Spain (P.G.); and Biochemistry and Molecular Biology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Spain (J.O.-L.).
authors.forename: Andreu
authors.initials: A
authors.lastname: Ferrero-Gregori
authors.affiliation: From Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Spain (J.A.-G., M.V.-B., A.F.-G., A.S.-P., J.C.); Department ESAII, EUETIB, Universidad Politécnica de Cataluña, Barcelona, Spain (P.G.); and Biochemistry and Molecular Biology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Spain (J.O.-L.).
authors.forename: Antoni
authors.initials: A
authors.lastname: Serra-Peñaranda
authors.affiliation: From Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Spain (J.A.-G., M.V.-B., A.F.-G., A.S.-P., J.C.); Department ESAII, EUETIB, Universidad Politécnica de Cataluña, Barcelona, Spain (P.G.); and Biochemistry and Molecular Biology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, Universidad Autónoma de Barcelona, Spain (J.O.-L.).
authors.forename: Juan
authors.initials: J
authors.lastname: Cinca
mesh_terms: D000200:Action Potentials; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D009320:Atrial Natriuretic Factor / Q000097:blood; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003251:Constriction, Pathologic; D017023:Coronary Angiography; D003326:Coronary Circulation; D054059:Coronary Occlusion / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D003331:Coronary Vessels / Q000503:physiopathology*; D015716:Electrocardiography, Ambulatory; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006329:Heart Conduction System / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D016017:Odds Ratio; D057216:Propensity Score; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; D020107:Troponin T; D009320:Atrial Natriuretic Factor
keywords: PR segment deviation; angioplasty, balloon, coronary; atrial fibrillation; atrial standstill; coronary occlusion; myocardial infarction