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

Giovanni B. Forleo, Manfredi Tesauro, Germana Panattoni, Domenico G. Della Rocca, Lida P. Papavasileiou, Domenico Sergi, Arianna Di Molfetta, Luca Santini, Francesco Romeo

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)402-407
Number of pages6
JournalHeart
Volume98
Issue number5
DOIs
Publication statusPublished - Mar 2012

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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