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.
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.
Authors: Giovanni B Forleo; Luca Santini; Massimiliano Campoli; Mario Malavasi; Alberto Scaccia; Maurizio Menichelli; Umberto Riva; Filippo Lamberti; Giovanni Carreras; Serafino Orazi; Valentina Ribatti; Luigi Di Biase; Mariolina Lovecchio; Andrea Natale; Sergio Valsecchi; Francesco Romeo Journal: J Interv Card Electrophysiol Date: 2015-04-28 Impact factor: 1.900
Authors: Michele Magnocavallo; Giampaolo Vetta; Domenico G Della Rocca; Carola Gianni; Sanghamitra Mohanty; Mohamed Bassiouny; Luca Di Lullo; Armando Del Prete; Donatello Cirone; Carlo Lavalle; Cristina Chimenti; Amin Al-Ahmad; J David Burkhardt; G Joseph Gallinghouse; Javier E Sanchez; Rodney P Horton; Luigi Di Biase; Andrea Natale Journal: Card Electrophysiol Clin Date: 2022-01-22
Authors: Michele Magnocavallo; Giampaolo Vetta; Alessia Bernardini; Agostino Piro; Maria Chiara Mei; Martina Di Iorio; Marco Valerio Mariani; Domenico G Della Rocca; Paolo Severino; Raffaele Quaglione; Giuseppe Giunta; Cristina Chimenti; Fabio Miraldi; Carmine Dario Vizza; Francesco Fedele; Carlo Lavalle Journal: Card Electrophysiol Clin Date: 2021-10-30
Authors: Agostino Piro; Michele Magnocavallo; Domenico Giovanni Della Rocca; Matteo Neccia; Giovanna Manzi; Marco Valerio Mariani; Martina Straito; Alessia Bernardini; Paolo Severino; Gino Iannucci; Giuseppe Giunta; Cristina Chimenti; Andrea Natale; Francesco Fedele; Carlo Lavalle Journal: J Cardiovasc Electrophysiol Date: 2020-09-30