Document Detail

Initial clinical results using intracardiac electrogram monitoring to detect and alert patients during coronary plaque rupture and ischemia.
MedLine Citation:
PMID:  20863952     Owner:  NLM     Status:  MEDLINE    
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.
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:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
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:
Created Date:  2010-09-24     Completed Date:  2010-10-19     Revised Date:  2012-03-08    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1089-98     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Borgess Heart Institute, Kalamazoo, Michigan, USA.
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MeSH Terms
Acute Coronary Syndrome / prevention & control*
Coronary Artery Disease / diagnosis*,  prevention & control
Electrocardiography, Ambulatory / methods*
Electrophysiologic Techniques, Cardiac / instrumentation*,  methods
Equipment Design
Equipment Safety
Follow-Up Studies
Middle Aged
Monitoring, Physiologic / methods
Myocardial Ischemia / diagnosis*,  prevention & control
Risk Assessment
Rupture, Spontaneous
Comment In:
J Am Coll Cardiol. 2012 Feb 7;59(6):631-3   [PMID:  22300701 ]

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