Effect of percutaneous transluminal coronary angioplasty on arrhythmias complicating angina

SUMMARY Four patients who had stenosis of a single major coronary artery which was treated by percutaneous transluminal coronary angioplasty are described. Three had exercise induced myo-cardial ischaemia complicated by ventricular tachycardia, fibrillation, and sinus bradycardia, respectively. Asystole developed in a fourth patient who had spontaneous chest pain. After successful percutaneous transluminal coronary angioplasty these arrhythmias did not recur spon-taneously or on treadmill exercise testing. Percutaneous coronary angioplasty can be effective in preventing arrhythmias complicating acute myocardial ischaemia secondary to stenosis of a single major coronary artery. Rhythm disturbance is a not uncommon compli-cation of coronary artery disease. New data derived from angiographic and haemodynamic studies of pa-tients resuscitated after sudden cardiac death had been imminent showed that in most (94%) the di-ameter of at least one major coronary artery had been reduced by 70 % or more. ' Antiarrhythmic drugs are usually given to prevent recurrence of arrhythmia. Alternative treatments are aneurysmectomy in se-lected cases,23 coronary artery bypass grafting,4 and endocardial excision guided by ventricular mapping in some others.5 We describe our experience with four patients who had exertional angina complicated by arrhyth-mia. They were all successfully managed by per-cutaneous transluminal coronary angioplasty. Case reports CASE 1 A 34 year old man with a three month history of exertional angina was referred to a district general hospital. His resting electrocardiogram was normal. He was receiving atenolol, isosorbide mononitrate, and nifedipine. A Master's two-step exercise test6 Requests for reprints to Dr A 0 Molajo, Regional Cardiac Centre