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Cardiology Insights 2019 Journal of Heart and Cardiovascular Research
ISSN: 2576-1455 Page 25
March 07-08, 2019
Berlin, Germany
New Horizons in Cardiology
& Cardiologists Education
22nd International Conference on
Complex proximal right coronary artery chronic total
occlusion, in patient affected by dilated ischemic
cardiomyopathy, with low EF and sustained ventricular
arrhythmias
Tedeschi D
Istituto Clinico S.Anna, Italy
Background: Recent studies, systematic reviews
and meta-Analysis suggested that chronic coronary
artery total occlusion (CTO), especially infarct related,
increases risk of ventricular arrhythmia (VA), appropriate
implantable cardioverter defibrillator (ICD) therapy
and all-cause mortality in ischemic cardiomyopathy
(ICM) patients. However it’s not clear whether these
threatening arrhythmic events could be prevented by
revascularization (CTO-PCI) and the impact of CTO-PCI
on the outcome of patients with CTO.
Conclusion & Significance: The clinical case presented
has a significant interest andcanbe reason for discussion
for the following reasons:
Specific clinical setting as rational to CTO-PCI:
No typical angina, no chest pain, no dyspnea Chronic
total occlusion dating back to 1991 (mono-vessel
disease) Cardiomyopathy with Low EF 35% and
recurrent threatening ventricular arrhythmiasFailure of
antiarrhythmic drugs Electric therapy ineffective (ICD;
CRT-D)
Challenging Long CTO-PCI, with some technical
procedure features, good angiographic result.
The clinical utility and effectiveness of RCA CTO
recanalization clearly demonstrated by clinical and
unquestionable instrumental data (complete absence of
VA after the PCI). According to a recent meta-analysis
involving 1095 patients, the presence of CTO increased
the risk of VA and all-cause mortality in ICD-ICM patients
up to 60 and 71 percent, respectively. Few data has been
published to demonstrate the role of CTO-PCI in patients
with recurrent VA, appropriate ICD shock and ischemic
cardiomyopathy. In this case the analysis of the clinical
history and above all of the ICD remotemonitoring, allows
a brilliant demonstration of the crucial role of CTO-PCI in
patients with recurrent VA and evidence of viability or
reversible ischemia on the CTO territory. Further studies
are needed to confirm these outcomes and to better
classify patients who would benefit from a CTO-PCI in
this specific clinical setting.
Tedeschi D, J Heart Cardiovasc Res 2019, Volume 3
DOI: 10.21767/2576-1455-C1-002