The relationship between the degree of collateral circulation and atrial electromechanical delay and p wave dispersion in patients with coronary collateral circulation

Introduction and Aim Coronary collateral circulation (CCC) consists of vascular channels which are activated to maintain perfusion in major epicardial coronary arteries in the development of severe stenosis. The presence of well developed CCC may prevent myocardium from ischemic damage and may improve the prognosis of coronary artery disease. It is known that myocardial ischemia may cause cardiac electrical instability. In this study, it was aimed to assess P wave dispertion (PWD), minimum and maximum P wave duration, intra-atrial and inter-atrial electromechanic delay (AEMD); which are predictors of atrial fibrilation in patients with CCC and evaluate the relation between these parameters and Rentrop classification which shows the degree of collateral development. Method 70 patients with CCC and ? 95% diameter stenoses along the proximal part of left circumflex artery or right coronary artery (35 patients with good collateral development, and 35 patients with poor collateral development); also 35 healty controls with angiographically proven normal coronary arteries were included in the study. Collateral classification was made according to Rentrop classification. Rentrop 0-1 collateral development were regarded as poor development whereas Rentrop 2-3 collateral development were regarded as good development. Maximum and minimum P wave duration and PWD of all participants were measured on electrocardiography and intra-AEMD and inter-AEMD were measured by echocardiography in all participants. Findings The demographic characteristics and main echocardiographic parameters were not different between the threee groups (p> 0.05). Maximum and minimum P wave duration (p<0.001), PWD (p<0.001), inter-AEMG (p<0.01), left intra-AEMD (p<0.05) and right intra-AEMD (p<0.001) were significantly longer in poor collateral developed group when compared with other groups. Post-hoc analyse showed that, there was no significant difference (p>0.05) between the good collateral developed group and control group in term of maximum and minimum P wave duration, PWD, inter-AEMG and left intra-AEMD in our study. Results The presence of good collateral development may be protective for development of atrial fibrillation in patients with chronic coronary artery disease. Patients with poor collateral development should be evaluated for possible development of the atrial fibrillation.