| Initial clinical results using intracardiac electrogram monitoring to detect and alert patients during coronary plaque rupture and ischemia. | |
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MedLine Citation:
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PMID: 20863952 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: We report the first clinical studies of intracardiac ST-segment monitoring in ambulatory humans to alert them to significant ST-segment shifts associated with thrombotic occlusion. BACKGROUND: Despite improvements in door-to-balloon times, delays in symptom-to-door times of 2 to 3 h remain. Early alerting of the presence of acute myocardial infarction could prompt patients to seek immediate medical evaluation. METHODS: Intracardiac monitoring was performed in 37 patients at high risk for acute coronary syndromes. The implanted monitor continuously evaluated the patients' ST segments sensed from a conventional pacemaker right ventricle apical lead, and alerted patients to detected ischemic events. RESULTS: During follow-up (median 1.52 years, range 126 to 974 days), 4 patients had ST-segment changes of ≥3 SDs of their normal daily range, in the absence of an elevated heart rate. This in combination with immediate hospital monitoring led to angiogram and/or intravascular ultrasonography, which confirmed thrombotic coronary occlusion/ruptured plaque. The median alarm-to-door time was 19.5 min (6, 18, 21, and 60 min, respectively). Alerting for demand-related ischemia at elevated heart rates, reflective of flow-limiting coronary obstructions, occurred in 4 patients. There were 2 false-positive ischemia alarms related to arrhythmias, and 1 alarm due to a programming error that did not prompt cardiac catheterization. CONCLUSIONS: Shifts exceeding 3 SD from a patient's daily intracardiac ST-segment range may be a sensitive/specific marker for thrombotic coronary occlusion. Patient alerting was associated with a median alert-to-door time of 19.5 min for patients at high risk of recurrent coronary syndromes who typically present with 2- to 3-h delays. |
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Authors:
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Tim A Fischell; David R Fischell; Alvaro Avezum; M Sasha John; David Holmes; Malcolm Foster; Richard Kovach; Paulo Medeiros; Leopoldo Piegas; Helio Guimaraes; C Michael Gibson |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 56 ISSN: 1558-3597 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-09-24 Completed Date: 2010-10-19 Revised Date: 2012-03-08 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 1089-98 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Borgess Heart Institute, Kalamazoo, Michigan, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Coronary Syndrome
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prevention & control* Aged Coronary Artery Disease / diagnosis*, prevention & control Electrocardiography, Ambulatory / methods* Electrophysiologic Techniques, Cardiac / instrumentation*, methods Equipment Design Equipment Safety Female Follow-Up Studies Humans Male Middle Aged Monitoring, Physiologic / methods Myocardial Ischemia / diagnosis*, prevention & control Recurrence Risk Assessment Rupture, Spontaneous |
| Comments/Corrections | |
Comment In:
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J Am Coll Cardiol. 2012 Feb 7;59(6):631-3
[PMID:
22300701
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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