Arrhythmias and Coronary Slow Flow: A Potential Pathogenic Link

Summary

This review summarizes Coronary Slow Flow (CSF) as a multifactorial syndrome associated with microvascular dysfunction, inflammation, and arrhythmias, highlighting the need for further research into its mechanisms and therapeutic strategies.

Abstract

Coronary slow flow (CSF) is characterized by recurrent resting angina and delayed distal vessel filling, despite the absence of obstructive coronary artery disease on angiography. With the continuous advancement of coronary interventional techniques, cardiologists have increasingly recognized CSF as a distinct phenomenon, and its pathogenesis has become a major research focus. Arrhythmias, common cardiovascular conditions, often present with clinical manifestations similar to those of CSF. Moreover, both conditions share certain pathogenic factors and pathophysiological processes, including endothelial dysfunction, inflammation, autonomic imbalance, and microvascular abnormalities. A clearer understanding of these overlapping mechanisms may help clinicians manage patients with CSF more scientifically and comprehensively. The present review summarizes the proposed pathogenic mechanisms of CSF, including microvascular disorders, endothelial dysfunction, inflammation, arrhythmias, anatomical factors, early atherosclerosis, and genetic polymorphisms. It also discusses the possible association between CSF and arrhythmias, highlights current uncertainties regarding causality, and considers how these mechanisms may broaden future therapeutic perspectives for this disease.

Introduction

The incidence of coronary slow flow (CSF) in patients undergoing coronary angiography (CAG) is reportedly between 1% and 7%^1,2,3, a range possibly related to differences in the definition of CSF, study populations, diagnostic criteria, and geographic setting. Clinically, CSF often manifests as precordial discomfort, chest tightness, chest pain, panic, and fatigue—symptoms that are difficult to promptly distinguish from other cardiac conditions and may be associated with poor clinical prognosis. Studies have shown that CSF is associated with adverse cardiovascular events....