Real-Time Detection and Alerting for Acute ST-Segment Elevation Myocardial Ischemia Using an Implantable, High-Fidelity, Intracardiac Electrogram Monitoring System With Long-Range Telemetry in an Ambulatory Porcine Model

Fischell, Tim A.; Fischell, David R.; Fischell, Robert E.; Virmani, Renu; DeVries, Jennifer J.; Krucoff, Mitchell W.

doi:10.1016/j.jacc.2006.07.058

Cited by 33 publications

(21 citation statements)

References 20 publications

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“…In an animal study, changes in the ST-segment recorded by implanted leads occurred earlier than those recorded from surface ECG leads, thus conferring an ability to quickly detect myocardial ischemia. 28,29 Innovative technology that uses specialized electrodes that measure pectoral muscle bioimpedance has suggested that changes in tissue impedance can provide estimates of systemic blood pressure. 30 …”

Section: Identification Of Clinical Deteriorationmentioning

confidence: 99%

Remote Monitoring of Patients With Implanted Cardiac Devices

Kusumoto

Goldschlager

2010

Clinical Cardiology

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Three different types of implantable cardiac devices are now commonly used in clinical medicine: pacemakers (including cardiac resynchronization systems), cardiac defibrillators, and loop recorders. Although pacing specialists and electrophysiologists have traditionally been responsible for device follow‐up, the newest generation of implanted devices stores a wealth of information that can be useful to the clinical cardiologist. Important information, in addition to device function, such as incidence and type of arrhythmias, general clinical condition of the patient, and hemodynamic status can now be stored on large databases that are available via web access to all physicians caring for an individual patient. The advent of the remote monitoring capability of implanted devices has initiated a rapidly accelerating paradigm shift in device follow‐up that can potentially improve patient care at lower cost. Copyright © 2010 Wiley Periodicals, Inc.

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Section: Identification Of Clinical Deteriorationmentioning

confidence: 99%

Remote Monitoring of Patients With Implanted Cardiac Devices

Kusumoto

Goldschlager

2010

Clinical Cardiology

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“…Intracardiac ECGs are superior at detecting ischemia compared with body‐surface ECGs and can detect ischemia earlier than surface ECGs 9, 10, 11, 12. A comparison of the intracardiac ECG vectors of an ischemic state—from the tip of the right ventricle (RV) to the ICD can, from the tip of the RV to the right atrium (RA), and from the RA to the ICD can—showed that the ST change in the intracardiac ECG from the tip of the RV to the ICD can was sensitive 11.…”

Section: Introductionmentioning

confidence: 99%

Continuous ST‐Monitoring Function of Implantable Cardioverter Defibrillator Detects Silent Ischemia in Patients With Coronary Artery Disease

Watanabe¹,

Hirooka

Furukawa

et al. 2018

JAHA

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BackgroundNewer implantable cardioverter defibrillators can monitor intracardiac ECGs , but their ability to detect ischemia is unclear. This study investigated the usefulness of implantable cardioverter defibrillators with an ST‐monitoring function in coronary artery disease patients.Methods and ResultsWe conducted a prospective study of implantable cardioverter defibrillator patients with the ST‐monitoring function. One hundred seventy‐three patients who received implantable cardioverter defibrillators for primary or secondary prevention of sudden cardiac death. All patients underwent medical examinations at least every 6 months, with standard 12‐lead ECGs and device checks that included analysis of the ST‐monitoring function. Myocardial perfusion imaging or coronary angiography was performed during the follow‐up. The mean follow‐up duration was 23.3±7.7 months. Significant ST changes occurred in 15 patients (8.7%), of whom 14 were asymptomatic. The incidence of angina pectoris was significantly higher in the ST change (+) group than that in the ST change (−) group (28.6% versus 7.2%, P=0.03). In the patients who underwent myocardial perfusion imaging, the sensitivity, specificity, and negative predictive value of the ST‐monitoring feature to detect ischemia were 75.0%, 72.5%, and 93.5%, respectively. The sensitivity, specificity, and negative predictive value of the ST‐monitoring feature to predict residual stenosis evaluated using coronary angiography were 76.9%, 83.5%, and 97.5%, respectively. The percentage of patients with a septal right ventricular lead was significantly lower in the ST change (+) group than in the ST change (−) group (13.5% versus 33.5%, P=0.01).ConclusionsIf intracardiac ECGs ST changes are detected, it is necessary to use additional modalities even in asymptomatic patients.Clinical Trial RegistrationURL: http://upload.umin.ac.jp. Unique identifier: UMIN000011824.

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“…Early detection and prompt intervention of an acute myocardial infarction significantly improves the clinical outcome. The mean time from myocardial infarction symptom onset to arrival at a hospital for treatment is about 2.5 to 3 hours [2,3]. Surveys and focus groups of heart patients, family members, and the public report that they thought the presenting symptoms were less dramatic then expected.…”

Section: Background and Clinical Importancementioning

confidence: 99%

“…Many patients take a "wait and see" approach until they are more certain of the symptoms significance [4]. A large proportion of irreversible myocardial injury and fatal ventricular arrhythmias occur in the first several hours after closure of a coronary artery [2,3]. The longer the time between closure of the artery and the treatment lead to further myocardial necrosis and worse clinical outcomes [3].…”

Section: Background and Clinical Importancementioning

confidence: 99%

“…A large proportion of irreversible myocardial injury and fatal ventricular arrhythmias occur in the first several hours after closure of a coronary artery [2,3]. The longer the time between closure of the artery and the treatment lead to further myocardial necrosis and worse clinical outcomes [3]. Treatment could include a defibrillation shock if the patient has an irregular heart arrhythmia, medication to help dissolve blood clots and open a blocked coronary artery, or a stent placement to open the blocked coronary artery.…”

Section: Background and Clinical Importancementioning

confidence: 99%

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St. Jude Medical: ST Monitoring

Kinney¹

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Myocardial infarction is the leading cause of death in the western world. Time is critical when treating patients with myocardial infarction. The major problem is that many patients who are symptomatic wait too long before seeking medical attention, and some patients have no symptoms at all. In order to improve patient outcome there needs If this is shown then the ST Monitoring algorithm can be used to reliably notify patients that they are having a significant cardiac event and need to seek medical attention immediately.

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Real-Time Detection and Alerting for Acute ST-Segment Elevation Myocardial Ischemia Using an Implantable, High-Fidelity, Intracardiac Electrogram Monitoring System With Long-Range Telemetry in an Ambulatory Porcine Model

Cited by 33 publications

References 20 publications

Remote Monitoring of Patients With Implanted Cardiac Devices

Remote Monitoring of Patients With Implanted Cardiac Devices

Continuous ST‐Monitoring Function of Implantable Cardioverter Defibrillator Detects Silent Ischemia in Patients With Coronary Artery Disease

St. Jude Medical: ST Monitoring

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