Conus branch (CB) of right coronary artery is known to be a major artery feeding right ventricular outflow tract (RVOT). We observed some cases with selective occlusion of CB during cardiac catheterization study. Total occlusion of CB was induced either by wedging catheter in CB or selective spasms of CB. Results: Few minutes after occlusion, marked ST elevation developed in lead Vl-3 in all cases. ST elevation accompanied with negative T similar to "coved form" ST-T in Brugada syndrome was observed in every case, which was different from typical configuration of convex ST elevation in acute ischemia. In some cases, ST-T oscillated between "coved" and "saddle back" form. QTc was slightly prolonged. Different from the cases with LAD-occlusion, reciprocating ST change in II, III, aVF, or V4-6 was obscure or absent. After restoration of coronary flow, ST segment immediately returned to isoelectric line in all cases. Conclusion: With the selective ischemia in RVOT area, local and marked ST elevation was observed in Vl-3. ST-T configuration similar to Brugada syndrome, which is known as a "RVOT desease", suggests that some electrophysiological characteristics of RVOT area modifies ischemic ECG configuration in these cases.
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