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Impact of continuous intracardiac ST-segment monitoring on mid-term outcomes of ICD-implanted patients with coronary artery disease. Early results of a prospective comparison with conventional ICD outcomes
  1. Giovanni B Forleo1,
  2. Manfredi Tesauro1,
  3. Germana Panattoni1,
  4. Domenico G Della Rocca1,2,
  5. Lida P Papavasileiou1,
  6. Domenico Sergi1,
  7. Arianna Di Molfetta3,
  8. Luca Santini1,
  9. Francesco Romeo1
  1. 1Division of Cardiology, Department of Internal Medicine, University of Rome “Tor Vergata”, Rome, Italy
  2. 2Department of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
  3. 3Institute of Clinical Physiology, Section of Rome, National Research Council (CNR), Rome, Italy
  1. Correspondence to Dr Giovanni B Forleo, Division of Cardiology, University Hospital of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; forleo{at}me.com

Abstract

Background Although myocardial ischaemia monitored by some implantable cardioverter-defibrillators (ICDs) might improve patient care, the clinical usefulness of this technology has not yet been validated.

Objective To investigate the potential impact of ICD-based ischaemia monitoring on clinical care and patient management of ICD recipients.

Design Prospective, controlled, non-randomised study.

Setting Single-centre, university hospital.

Patients Consecutive patients with known coronary artery disease, followed up for at least 6 months.

Interventions Patients implanted with either an ICD providing continuous intracardiac ST monitoring (n=53; ST group) or with an ICD without this capability (n=50).

Main outcome measures Major cardiovascular events, appropriateness of ST-shift episodes and unscheduled device-related visits.

Results During follow-up (15.4±8.4 months), one patient experienced ST-shift events confirmed by angiography to be related to myocardial ischaemia. Myocardial infarction was a rare event and occurred in one patient (ST group) who had an ST-elevation myocardial infarction 3 weeks after the implant, but at this time the algorithm had not yet been activated. In the ST group, seven patients had one or more episodes of false-positive ST events (median 9, range 1–90). The programmable features of the device helped overcome the problem in six patients. Among patients with a remote monitoring system, unscheduled outpatient visits were significantly increased in the ST group (17 vs 4; p=0.032).

Conclusions Although, this study was underpowered by the small number of acute ischaemic events, ICD-based ST monitoring failed to provide a benefit over ICDs without this capability and increased unscheduled evaluations in patients with remote follow-up. The sensitivity and specificity of the algorithm still require validation.

  • Coronary artery disease
  • continuous monitoring
  • intrathoracic electrogram
  • myocardial ischaemia
  • ST segment
  • Atrial fibrillation
  • implantable cardioverter defibrillator (ICD)
  • pacemakers
  • radiofrequency ablation (RFA)
  • cardiac resynchronisation therapy
  • implantable cardioverter defibrillator (ICD)
  • pacemakers
  • coronary physiology

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Footnotes

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the ethics committee of the University of Tor Vergata.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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