The Intracoronary Electrocardiogram in Percutaneous Coronary Intervention

Abstract

The technique of obtaining an epicardial electrocardiogram trace by connecting the guidewire during coronary angioplasty to an electrocardiogram lead has been used since 1985. The intracoronary electrocardiogram appears to be more sensitive than the surface electrocardiogram in detecting transient ischemia, particularly in the territory of the left anterior descending and left circumflex coronary arteries. Importantly, recent studies have shown the intracoronary electrocardiogram to be particularly useful in demonstrating pre- and postconditioning during interventional procedures, predicting periprocedural myocardial damage, and in the determination of regional viability in the catheterization laboratory. Barriers to the use of the intracoronary electrocardiogram in the clinical setting include the lack of standardized methods for acquiring and analyzing the intracoronary electrocardiogram, and the lack of commercially available continuous intracoronary monitoring systems to permit analysis while performing coronary interventions. Facilitating these relatively simple technical developments may permit optimal integration of the intracoronary electrocardiogram into the catheterization laboratory.

Intracoronary electrocardiogram during alcohol septal ablation for hypertrophic obstructive cardiomyopathy predicts myocardial injury size

“…The observation of the significant correlation between ST‐segment elevation and the measure of myocardial injury implies that IC‐ECG may be helpful in determining the amount of ethanol to be used. Unipolar IC‐ECG recording from a guide‐wire electrode has been shown to be more sensitive and reliable than standard 12‐lead ECG in detecting regional myocardial damage during coronary intervention . Indeed, in our study, significant ST‐segment elevation on IC‐ECG was present in all 21 patients after ethanol injection, while no patients showed ST‐segment elevation (≥ 0.1 mV) from the isoelectric line on the surface ECG leads.…”

Prognostic and diagnostic accuracy of intracoronary electrocardiogram recorded during percutaneous coronary intervention: a meta-analysis

“… 27 However, surface ECG was not reliable for detecting local myocardial ischaemia during PCI procedures in real time. 28 In this case, IC-ECG was more reliable and sensitive for detecting local ischaemia. 29 Although IC-ECG was more sensitive than surface ECG when assessing left ascending artery and circumflex territory, It should be noted that IC-ECG was less sensitive when assessing right coronary artery territory.…”

“…And ST-segment deviation recorded by surface ECG was a part of the universal definition of myocardial infarction 27. However, surface ECG was not reliable for detecting local myocardial ischaemia during PCI procedures in real time 28. In this case, IC-ECG was more reliable and sensitive for detecting local ischaemia 29.…”

Desnível do segmento ST ao eletrocardiograma intracoronário como preditor de infarto periprocedimento na intervenção coronária percutânea em doença arterial coronária estável

“…65 Até o momento, os trabalhos publicados buscaram, com êxito, demonstrar a associacao entre alterações isquemicas ao ECG-IC e níveis de marcadores de injúria miocárdica pós procedimento. 52,96,99,105,110,111 Apesar da definição universal de IAM mencionar incidência aproximada de 30% de infarto periprocedimento, tipo 4a, não é o que observamos na prática assistencial diária, sendo um evento incomum nos tempos atuais. 40 Ao empregar a expectativa de evento citada como premissa no cálculo amostral, limitamos o tamanho da população de estudo, o que em última instância diminuiu o poder desta pesquisa em investigar uma possível associação entre desnivelamento do ST-IC durante ICP e o nosso desfecho primário, com o achado de apenas um caso (1,9%) de infarto tipo 4a.…”

“…83 Desse modo, a utilização apenas das derivações do plano frontal (D1, D2, D3, aVL, aVF e aVR) para monitorização eletrocardiográfica contínua reduz a chance de flagrar alterações isquêmicas -especialmente desvios do segmento ST -durante o procedimento.Em um registro eletrocardiográfico de superfície, a magnitude da corrente de injúria miocárdica aguda é inversamente proporcional à distância do eletrodo explorador em relação ao território isquêmico 91,96,97. De modo oposto, um eletrodo epicárdico é mais sensível na detecção eletrocardiográfica de alterações isquêmicas do segmento ST do que um registro de superfície, podendo identificar não apenas isquemia de grau discreto, como isquemia severa em segmentos miocárdicos mais localizados, subavaliados ao ECG-S [96][97][98][99]. Com base nesse racional eletrofisiológico, Hashimoto et al100 descreveram em 1974, pela primeira vez, o uso do eletrocardiograma intracoronário (ECG-IC) para avaliação de isquemia miocárdica.…”