Article Text
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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- 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
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.